Quality of Life of Persons Suffering from Schizophrenia, Psoriasis and Physical Disabilities.

BACKGROUND: Studies have addressed the impact of chronic diseases and their treatment on quality of life (Qol), but the relative impact of different chronic conditions on patients' level of subjective functioning is mostly unknown. Stigma is associated with poor Qol in various chronic diseases. The aim of this study was to compare the quality of life of people suffering from schizophrenia with the quality of life of patients with psoriasis and physical disabilities. SUBJECTS AND METHODS: Study was conducted on a sample of 88 persons suffering from schizophrenia, 60 persons with physical disabilities and 57 persons with psoriasis. All three groups completed The Scale of Life-Quality assessment. RESULTS: Persons suffering from schizophrenia were less satisfied with their education level and social life. They were less satisfied with life if continued the same as present than persons with physical disabilities and people suffering from psoriasis. However, persons suffering from schizophrenia have higher expectations for the future than persons with physical disabilities and people suffering from psoriasis. CONCLUSIONS: Our results show lower quality of life in the group of patients with schizophrenia in comparisons with group with physical disabilities and psoriasis, which indicates that it is necessary, not only to make the treatment of schizophrenia more successful, but also to improve the process of rehabilitation and social reintegration in order to increase the quality of life of people with schizophrenia.

Relations between the course of illness, family history of schizophrenia and family functioning in persons with schizophrenia.

The aims of this study were to identify the aspects of family functioning which are associated with the course and remission of schizophrenia and to explore relations between aspects of family functioning and family history of schizophrenia. The subjects were 90 patients, treated at the Clinical hospital centre in Rijeka, Croatia, with diagnosed schizophrenia (F20.0 to F20.5) and without psychiatric comorbidity. The patients were organized into three groups depending on the treatment status during the calendar year that preceded the year in which the survey took place: patients with schizophrenia who received an outpatient care and were maintaining favourable remission, patients who were hospitalized once to twice and patients who were hospitalized at least three times in the precedent calendar year. The treatment status was used as an indicator of the course of the illness. A Family Functioning Scale was applied and the data on the absence/presence of schizophrenia in the family history were collected through the examination of previous medical records. The lowest prevalence of familial schizophrenia was found among the patients who were maintaining favourable remission. Among the three groups statistically significant differences were found regarding the following family functioning variables: expressiveness, family sociability, democratic family style. Also there were observed statistically significant differences in the family functioning depending on the presence/absence of the schizophrenia in the family history that included following domains: family cohesion, external locus of control and democratic family style. Our study gives support to the conclusion that family functioning of persons with schizophrenia differs depending on the course of the illness and presence/absence of schizophrenia in the family history.

The impact of psoriasis on the quality of life and psychological characteristics of persons suffering from psoriasis.

Psoriasis, as same as other skin diseases, has an influence on many spheres of patient's life. It influences the mental image the patients have of themselves and it indirectly shapes their personality traits as well as it defines the quality of their lives. The purpose of the study was to examine the impact of psoriasis on the quality of life and gender differences in the quality of life and explore presence of neurotic symptoms among persons suffering from psoriasis in comparison to general population. During the treatment of persons suffering from psoriasis at the special hospital Naftalan in Ivanic Grad personality questionnaire and Quality of life scale were administered to 61 participants (m = 25; f = 36). Our results showed few gender differences in the satisfaction with specific life domains, but only differences in the satisfaction with sexual life could be related to the different effects psoriasis has on the quality of life of men and women. Our participants experience more anxiety and depression symptoms as well phobic fears in comparison to general population. Found genders differences in the presence and intensity of anxiety symptoms closely resemble those documented in the general population therefore aren't typical for people suffering from psoriasis.

Quality of life in people with physical disabilities.

The aim of this study was to examine the possible differences in self-reported quality of life of people with physical disabilities with regard to both socio-demographic and disability-related characteristics. Testing was conducted on 153 respondents with physical disabilities, residents of the City of Zagreb. Positive correlations were found between the quality of life and income satisfaction, residence size (per capita floor area) and level of residence equipment. Multivariate analysis of variance showed statistically significant differences in quality of life among respondents with regard to the marital status, work status and home ownership. Statistically significant differences in the quality of life were found among the participants depending on their level of physical mobility and type of physical disability. The level of physical mobility is associated with general satisfaction with the accomplishment of goals, aspirations and hopes. The type of physical disability is related to the satisfaction with leisure activities, with the material status, expectations to achieve in the future what has not formerly been achieved. There was also a significant relation between the type of physical disability and general satisfaction with life in the past year. Positive correlations between duration of disability and quality of life were found. Membership in associations of persons with physical disability and related benefits were shown to contribute to the quality of life.

Aggresiveness in institutionalised schizophrenic patients and the selection of antipsychotics.

The selection of antipsychotics as medications used primarily for treating schizophrenia and disorders similar to schizophrenia is an important aspect of the treatment of forensicpatients. This study examines the effect of antipsychotics selection (typical or atipycal) on the level of aggressiveness, side effects and the hospitalisation length. The research is conducted on 98 psychiatric patients diagnosed with schizophrenia or similar disorders (F 20-F 29) in two forensic psychiatric institutions. The patients committed aggressive criminal offence in state of insanity. The patients are currently treated in inpatient psychiatric institutions. The research was conducted by using the Aggressiveness Questionnaire (AG-87), the Simpson-Angus Scale for the assessment of extrapyramidal side effects, the Barnes Akathisia Rating Scale for the assesment of akathisia and the Abnormal Involuntary Movement Scale. The results show no significant difference between the groups of patients treated with typical and atypical antipsychotics in all the variables.

Antipsychotic treatment--side-effect and/or metabolic syndrome.

According to current medical opinion chronic mental diseases such as schizophrenia require life-long treatment. The choice of antipsychotics is an important treatment factor, since their side-effects often influence patients' compliance with treatment. Severe side-effects may cause the patients to reject such treatment, the latter being their right. In case a psychiatrist does not agree with the patient's decision to interrupt his antipsychotic treatment regardless its serious side-effects, the former should be persistent in convincing the patient to replace such drug with a more appropriate therapy.

Allergic reactions--outcome of sertraline and escitalopram treatments.

The treatment of dysthymia in itself poses a problem in the everyday psychiatric practice and it can be further hindered when accompanied by pronounced personality traits (which are indicative of disorder). Due to its pathology and duration dysthymia interferes with the patient's quality of life and the ability to function in some segments of everyday life. These interferences enticed our patient to opt for psychiatric treatment. During a three-year period, despite all the efforts made by psychiatrists in this comprehensive and challenging dysthymia treatment (psychotherapy, group psychotherapy, psychopharmacotherapy), the expected outcomes of the treatment did not occur. The patient's goals and expectations included lifestyle change, achieving life satisfaction and mood improvement. The patient was refusing suggested psychopharmaca until confronted, in psychotherapy, with the fact that she is the one prolonging her own helplessness and directing her passive agression at the members of the group. In the end the patent agreed to take psychopharmaca. Therefore, sertraline was introduced in the treatment, but the patient experienced a severe allergic reaction (Qiuncke's oedema). After four months the second attempt was made and escitaloptam was introduced, which resulted in urticaria. Due to these allergic reactions to antidepressants, the patient decided not to pursue the psychopharmacological treatment.

Obtaining the child testimony in the criminal proceedings.

Children fall under the special category of vulnerable witnesses. Children's vulnerability is the reason that we must approach obtaining the child's testimony in the criminal proceedings with special attention. It is important to take the child's testimony as soon as possible and to avoid the repetition of interrogation. The criminal proceedings law and the juvenile court law enable children interrogation through the professional person without the presence of other parties in the procedure and enable the recording of such interrogation by audio-video link which considerably diminish the secondary victimization. The professionals who obtain the testimony must be well acquainted with children's psychological development. Knowledge of psychological development is of major importance in order to make the quality arrangements for interrogation and to interrogate the child and to achieve positive social contact between the examiner and the examinee and it is also of great importance for the credibility evaluation of the child's testimony. The adequate way of children interrogation will enable the child to say the correct information and to recognize the perpetrator. The forensic interview is well elaborated and child adapted technique of interrogation. Respecting the rules of forensic interview will enable the child's testimony on court to be relevant evidence.

Relationship between comorbidity and violence risk assessment in forensic psychiatry - the implication of neuroimaging studies.

Violence is an important social problem. Violence in the community has important social relevance for the political, criminal justice, and health care systems. Studies of homicide offenders have suggested a high prevalence of neurologic dysfunction due to organic brain damage such as traumatic brain injury, epilepsy and dementia have been observed to exhibit excessive violence. Moreover, violence in the mentally ill can be viewed as an important medical and mental health problem with significant implications for forensic psychiatry and the community. Although numerous previous studies showed that rate of violent behavior in the community is not much higher in patients with serious mental disorders (schizophrenia) than in healthy controls, that rate is substantially higher in patients with psychiatric comorbidity and substance abuse. A high proportion of patients in forensic psychiatric facilities are diagnosed with comorbidity, most often with schizophrenia, paranoid psychosis, organic brain syndrome, various personality disorders and comorbid substance abuse. These patients represent a high risk group for violence within forensic psychiatric facilities, and repetitive violent behavior in the community. Understanding the neurobiological basis of aggressive behavior clearly has important social and clinical implications. By introduction of neuroimaging studies (MRI, fMRI, PET, SPECT) as a useful tool in forensic psychiatry, the neurobiological aspect of violence is better understood. Previous studies have shown that individuals with frontotemporal brain dysfunction are frequently displaying antisocial behavior (disinhibition, impulsivity, lack of empathy) that justify the diagnosis of "acquired sociopathy/psychopathy". A correlation between the potential for impulsive aggression mediated by limbic brain structures, and the control of the aggression by frontotemporal brain regions has been shown. The individuals with such brain dysfunction have an increased risk of violent behavior and scored high on the Webster's and Hare's violence risk assessment scale. This article reviews the relationship between psychiatric comorbidity, violence risk assessment and neuroimaging in forensic psychiatry and showing the useful directions for future research, screening and prevention of violent behavior among mentally ill criminal offenders.

Metabolic syndrome - the consequence of lifelong treatment of bipolar affective disorder.

Mood disturbances are characteristic and dominant feature of Mood disorders. Bipolar Affective Disorder (BAD) is a mood disorder which occurs equally in both sexes. BAD may occur in co morbidity with other mental diseases and disorders such as: Anorexia Nervosa, Bulimia Nervosa, Attention Deficit, Panic Disorder and Social Phobia. However, medical disorders (one or more) can also coexist with BAD. Metabolic syndrome is a combination of metabolic disorders that increase the risk of developing cardiovascular disease. A 61-year old female patient has been receiving continuous and systematic psychiatric treatment for Bipolar Affective Disorder for the last 39 years. The first episode was a depressive one and it occurred after a child delivery. Seventeen years ago the patient developed diabetes (diabetes type II), and twelve years ago arterial hypertension was diagnosed. High cholesterol and triglyceride levels as well as weight gain were objective findings. During the last nine years she has been treated for lower leg ulcer. Since metabolic syndrome includes abdominal obesity, hypertension, diabetes mellitus, increased cholesterol and serum triglyceride levels, the aforesaid patient can be diagnosed with Metabolic Syndrome. When treating Bipolar Affective Disorder, the antipsychotic drug choice should be careful and aware of its side-effects in order to avoid the development or aggravation of metabolic syndrome.

Forensic aspects of alcohol abuse and homicide.

Numerous investigations indicate a close link between violent behavior, homicide (murder) and alcohol intoxication. With increased frequency of drinking and the chronic consummation of alcohol, the risk of the fatal outcome or homicide and victimization caused by violence is more likely to occur. Studies conducted on convicted murderers suggested that about half of them were under the heavy influence of alcohol at the time of perpetration of murder. The sample in this survey consisted of 177 male offenders which committed criminal act of murder in Croatia from the year of 1990 until 2007 (capital murder and attempted murder). All were assigned for the forensic psychiatric evaluation by the Criminal Justice System (Court of Law) at the Department of Forensic Psychiatry, Neuropsychiatric Hospital, Popovaca, Croatia. For the purpose of this work the sample is divided in two groups of subjects: 1) offenders which were intoxicated at the time of murder and committed offence on intoxicated victim 2) offenders who were sober and committed offence on sober victims. Groups are compared according to the variables of crime and history of alcohol abuse. On the basis of obtained results we can conclude that there are significant differences in relation to the variables and modalities of criminal offence between two groups of offenders and victims. We could conclude that alcohol intoxication in offenders and victims at the time of murder could strongly affect the modalities of murder.

Psychiatric comorbidity in forensic psychiatry.

For the past several years a numerous studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse. The comorbid substance abuse in violent offenders was usually unrecognized and misdiagnosed. Furthermore, comorbidity in forensic psychiatry describes the co-occurrence of two or more conditions or psychiatric disorder known in the literature as dual diagnosis and defined by World Health Organization (WHO). In fact, many violent offenders have multiple psychiatric diagnoses. Recent studies have confirmed causal relationship between major psychiatric disorders and concomitant substance abuse (comorbidity) in 50-80% of forensic cases. In general, there is a high level of psychiatric comorbidity in forensic patients with prevalence of personality disorders (50-90%), mood disorders (20-60%) and psychotic disorders (15-20%) coupled with substance abuse disorders. Moreover, the high prevalence of psychiatric comorbidities could be found in mentally retarded individuals, as well as, in epileptic patients. Drugs and alcohol abuse can produce serious psychotoxic effects that may lead to extreme violent behavior and consequently to serious criminal offence such as physical assault, rape, armed robbery, attempted murder and homicide, all due to an altered brain function and generating psychotic-like symptoms. Studies have confirmed a significant statistical relevance in causal relationship between substance abuse and violent offences. In terms of forensic psychiatry, the comorbidity strongly contributes in the process of establishing psychiatric diagnosis of diminished mental capacity or insanity at the time of the offence in the course of clinical assessment and evaluation of violent offenders. Today, the primary focus of forensic psychiatry treatment services (in-patient or community) is management of the violent offenders with psychiatric comorbidity which requires a multilevel, evidence based approach to the patient. Forensic treatment service effectiveness appears to be associated with individual case management and approach including psychotherapy, pharmacotherapy and occupational therapy in order to achieve optimal rehabilitation, prevention of recidivism and stability in social functioning of the patient in the community.

Forensic psychiatric evaluation of persons with posttraumatic stress disorder undergoing criminal trial.

The aim of our study was to determine if there is a difference between the type of crime committed by persons diagnosed with posttraumatic stress disorder (PTSD) and that committed by other offenders. The study included 389 male patients at the Department of Forensic Psychiatry in Popovaca who underwent forensic psychiatric evaluation to establish a psychiatric diagnosis, evaluate the mental capacity, and provide advice on further treatment. The data on the number of individuals with PTSD vs. other psychiatric disorders and the data on family violence vs. other criminal acts were analyzed with chi2 test. Of a total of 389 forensically evaluated male patients, 45 (11.6%) suffered from PTSD. Study subjects with PTSD only or PTSD comorbid with the other psychiatric disorders committed family violence significantly more often than subjects diagnosed with the other psychiatric disorders chi2(1) = 40.092, P < 0.001. Subjects with PTSD, whether or not comorbid with the other psychiatric disorders, committed family violence significantly more often than subjects with other psychiatric diagnoses.

Homicide and subsequent catatonia associated with a large arachnoid cyst: case report.

The existence of a focal brain lesion that might be the crucial cause for the development of diverse psychiatric phenomena and certain characteristics of personality is often a controversial issue. The patient was a 29-year-old male when he killed his father with a single knock with the blunt side of an axe. Subsequently to the act, the patient developed a 10-month-long catatonic stupor during which he experienced intensive fear, delusions, and affective symptoms. He was an emotionally blunted person with no medical record and without prior history of aggressive behavior. Magnetic resonance image revealed a large, right-sided arachnoid cyst that was associated with right temporal and frontal lobe hypoplasia and bilateral changes of perfusion in peri-insular regions. The treatment with clozapine and diazepam showed to be therapeutic. This could be the second case of homicide committed by a person with arachnoid cyst and without past history of aggression, and the second description of an adult patient with cyst who developed catatonic stupor. This is the first description of long-lasting organic catatonic stupor treated with clozapine and diazepam. Relevant literature is reviewed and some controversial issues are discussed.