Ethics, Psychiatry, Politics - Homo Moralis.

In this paper we see the personality of man through his comprehension as a moral entity. An entity that emerges, thinks morally and/or behaves morally, inseparable from the society in which he lives as a moral being, and by its moral thinking and/or behaviour further defines the morals of the whole society. Accordingly, we present (post)modern society as a society of tolerance of value ambiguity. In that kind of society we perceive medical situation as moral situation and define the role of medical ethics in the field of biomedicine. In that kind of society politics is perceived as one of the social spheres where different varieties of systems of values of individuals or groups are publicly embraced, touched, or terribly unhappily pursued... all in the name of understanding man and his world. In order to prevent the victory of Thanatos, who prevails in the contemporary concept of politics and in postmodern global society, we suggest implementing applied bioethics as a form of metapolitics as an answer. We explain the idea of bioethics and suggest bioethical education as the operationalisation of metapolitics through bioethics as orientation knowledge, in both medicine and politics.

Psychiatry and Society - Move Towards the Transdiciplinarity in Ethics and Politics.

A main aim of this paper is to critically turn to the cruciallity, and inevitability of the transdisciplinary approach in the context of the contemporary psychopathological stances of the individuals. In this paper, transdisciplinarity will be observed as a kind of necessity in the broadly differentiated disciplinarity of the modern societies. A given disciplinarity of the particular exacts sciences, in its self-sufficiency and the distance (paralaxis) from the other particular disciplines is forfeiting from sight a consciousness (and the self-consciousness) regarding the necessity of the focusing to the research object universality. Authors will propose thesis that transdiciplinarity is the shift towards the consciousness regarding the research object as the fundamental segment of the science. Following the given context, contemporary disciplinary boarders should be set a side and approach a certain phenomena un-hierarhically, through all the available scientific methods. In the frame of such placed predispositions of science, contemporary issue of more and more frequently presence of the neurotic must inevitably include psychiatric and psychological knowledge as the base, but certainly the sociological and philosophical knowledge as well, in the context of understanding etiology, socio-genesis and psychogenesis of the certain issue in the most adequate way. Only when the excluding hierarchisation of the disciplines, in the context of understanding the neurotical disorders, is set aside, a true impacts of the science can come to the fore. A given certainly includes analysis of the sociocultural context, psychosocial development of the individual, ethical social norming, development of the ones spirit and self of its own beingness, as well as the various development issues of the physiological structures of the human brain. In the given context, in this paper we will discuss a transdisciplinary synthesis of the psycho-therapeutical approaches along with the original sociological-philosophical variants of the socio-therapy.

The Sexuality of Sex Workers: Sexual Arousability and the Sexual Profile of Women Engaged in Prostitution in Serbia.

BACKGROUND: In a view of sex work being a sexual behavioural activity, the main objective of our research was to explore the sexuality of sex workers in Serbia regarding to intensity of their sexual arousability. SUBJECTS AND METHODS: The research was conducted on 30 sex workers and 30 controls of randomly selected social and demographic characteristics, without any signs of psychiatric morbidity. For the evaluation of the intensity of sexual arousability, SAI (Sexual Arousability Index) questionnaire was used. RESULTS: The analysis of the main total scores of the SAI for the sex workers and control participants showed no statistically significant difference in the overall intensity of arousability (p>0.05). However, item by item analysis of the questionnaire showed qualitative difference in sexuality between sex workers and controls, related to certain aspects of sexuality. CONCLUSIONS: These findings allow the space for further research in the way of identifying origins of qualitative issues in the sexual profile of sex workers, in correlation to women who are not sex workers, i.e. whether they had been result of potential biological, specific psychodynamic factors, or have been formed as a result of the direct influence of the sex work.

Prostitution as a Psychiatric Situation: Ethical Aspects.

This paper presents the morally controversial phenomenon of prostitution. As the basis for contemplating the prostitution issue the most important is revealing and understanding its primitive ethical root. For understanding its "soul", its essence, also important is comprehending sexual, "elementary thoughts" of mankind, through the relationship between prostitution and religious, social, political and spiritual life, and its nature as a reflection of the sexual-ethical concepts in different epochs and nations. We emphasize the connection between prostitution and psychiatry. Placing a special focus on importance of personality for deciding to become a prostitute, and by pulling it through a moral prism we define prostitution as a new medical situation. In favor of that, we stress the importance of the presence, position and role of psychiatrists within an indispensable multidisciplinary team, which is complementary despite its heterogeneousness, synergistically and simultaneously dealing with psychological, physical and social health-problems of women engaged in prostitution. We propose peer education as a way of promoting healthy and safer behaviors among the subculture of prostitutes, where we see another important role of psychiatrists in selecting/recruiting, training and motivating peer educators among them.

From Sarcopenia to Depressive Symptoms in Elderly: A Path Analysis.

BACKGROUND: Sarcopenia is an age-related progressive, generalized skeletal muscle disorder involving the accelerated loss of muscle function and muscle mass. The aim of this study was to assess the complex relationship between sarcopenia, malnutrition, cognitive impairment, physical activity, and depression in the elderly, with the potential role of quality of life as a mediator in these associations. METHODS: A cross-sectional study was conducted on a sample (n = 298) of elderly patients admitted to Special Hospital for Rehabilitation "Termal", Vrdnik, Serbia. Sarcopenia, the risk for malnutrition, cognitive impairment, physical activity, quality of life, and depressive symptoms were measured by standardized instruments. Additional data included sociodemographic characteristics. Simultaneous assessment of the direct and indirect relationships of all determinants was performed by path analysis. RESULTS: A total of 40% (n = 120) of the elderly were diagnosed with sarcopenia, and 42.6% had depression symptoms. The risk of malnutrition was present in 23.5%, cognitive impairment in 5.4%, and a low level of physical activity was reported in 26.2% of elderly participants. The mean reported quality of life measured by Sarcopenia and Quality of Life Questionnaire was 60 (on the scale ranging from 0 to 100; where a higher score reflects a higher quality of life). The best-fitted model (χ2/DF = 1.885, NFI = 0.987, CFI = 0.993, GFI = 0.997, RMSEA = 0.055) highlighted the mediating effect of quality of life between sarcopenia, malnutrition, cognitive impairment, lower level of physical activities and depression. According to the model, quality of life was a direct negative predictor of depressive symptoms in the elderly, while malnutrition positively affected depression. CONCLUSIONS: The presented path model may assist rehabilitation centers in developing strategies to screen for sarcopenia and risk of malnutrition, and promote physical activity in elderly, aiming to prevent their negative effects on mental health. For the elderly currently affected by sarcopenia, we consider regenerative medicine and stem cell therapy, which, in view of their etiology, could be a potential therapeutic strategy for sarcopenia.

Measurement of Bone Mineral Density in Children with Cerebral Palsy from an Ethical Issue to a Diagnostic Necessity.

INTRODUCTION: Due to concerns about cumulative radiation exposure in the pediatric population, it is not standard practice to perform dual-energy X-ray absorptiometry (DXA) analysis in the diagnostic process of musculoskeletal disorders, such as cerebral palsy (CP). This study aimed to evaluate the bone mineral density (BMD) in children with CP and the ethical justification of applying DXA analysis in these children. Material and Methods. In this monocentric retrospective analysis, data were collected from children and adolescents with CP who were treated for a primary illness for three years. A clinical examination, which included a DXA analysis, recommended by the multidisciplinary team, was performed. After applying inclusion and exclusion criteria, 60 scans remained for statistical analysis. BMD and Z-scores for the lumbar spine (LS), and hip right and left femoral neck (RFN and LFN, respectively), and total hip (TH) were recorded. RESULTS: The average age of children with CP when DXA analysis was first performed was about 7 years. The BMD (mean ± SD) at LS (LS-BMD) of all patients was 0.612 ± 0.12, at RFN 0.555 ± 0.11, at LFN 0.572 ± 0.1, and at TH (TH-BMD) 0.581 ± 0.13. The values of the Z-score (mean ± SD) at LS of all patients were -2.5 ± 0.22, at RFN -2.2 ± 0.21, at LFN -2.25 (SD = 0.2), and at TH -2.3 (SD = 0.23). There was no statistical significance between age and gender; however, BMI, walking ability, fracture history, and pattern of CP had a significant impact on BMD and Z-score values of these children. CONCLUSION: The results of our study clearly indicate that children with CP have a higher risk of low BMD, osteoporosis, and bone fractures, which makes it ethically justifiable to perform the DXA analysis in these children.

Knowledge and attitudes toward vaccination: A survey of Serbian students.

Since vaccination coverage in Serbia has been decreasing and health professionals have been identified as the most important factor in making decisions about immunization, vaccination knowledge and attitudes of students, especially medical students, are of particular interest. A cross-sectional survey was carried out on three groups of 509 Belgrade University students (medical, law and engineering students). The data were collected using an on-line questionnaire posted to student groups and included the Vaccine Knowledge Questionnaire and Attitudes Toward Vaccination Scale. This survey also included questions about demographic characteristics and perceived negative experiences. Multiple linear regression analysis was performed. There was a significant difference in the Vaccine Knowledge score (F=40.48, p<0.01) among the three groups of students. Medical students (N=251, Mean=4.47, SD=1.71) had significantly higher mean knowledge scores than did law (N=128, Mean=2.80, SD=1.56) or engineering students (N=130, Mean=3.98, SD=1.81). Compared with the law (Mean=49.77, SD=10.23) and engineering students (Mean=57.62, SD=12.21), medical students (Mean=59.52, SD=9.62) also had significantly higher attitude scores (F=37.56, p<0.01). These findings demonstrate general positive attitudes of Serbian students toward immunization. However, some knowledge gaps were identified. Multivariate analysis showed that those who had better vaccine knowledge, those who studies medicine, those who attended at university for more years, and those who do not know someone who had a negative experience with vaccines were more likely to have positive attitudes toward vaccination. Considering the growing vaccination hesitance in the general population, this is an important result that indicates that medical students are possible important participants in future public health campaigns. A strong association between vaccine knowledge and attitudes implies recommendations to introduce a specialized vaccination curriculum at both the undergraduate and graduate levels of medical study.

Forms of parasuicide in young people in Bosnia.

OBJECTIVE: This study is an investigation of parasuicidal presentations in young people in Bosnia during the period from 1992 to 2004. The other aims were: an analysis of the stress as well as the personal and emotional traits of suicidal subjects. METHODS: Two groups of young people were investigated: 90 with parasuicidal caracteristics and 90 controls who had experienced emotional and behavioral crises during adolescence. The study is longitudinal and stratified according to the qualities of the parasuicidal behaviour. The tests used in this study (LOP, Ci, CMI, EPQ-98 and P.I.E.) are statistically elaborated by standard descriptive and analytical methods. RESULTS: The results show the following factors to be highly significant: destruction and violence inside the families (p < 0.001) as well as migration and heredity (p < 0.05). Discriminative analysis (rc) confirmed group difference in neuroticism = 0.95541, F=38.321 with significance factor of p < 0.001. EPQ test in parasuicidal subjects shows high level of neuroticism and psychoticism while controls show extroversion and conformism. Canonical Fcn = 0.6634, rc = 0.771, df = 4 chi(2) = 85.73, p < 0.001. P.I.E. clearly differentiated parasuicidal group from adolescent, control group: Hi quadrant test chi(2) = 101.361 and statistical significance p < 0.001. Results show: 1. suicide: n = 7 (7.7%), parasuicide: n = 84 (43.6%) and maturation: n = 89 (48.9%). CONCLUSION: Representation of parasuicidal behaviour was found in both groups of examinees, but the forms are more represented in parasuicide. Sociodemographic difference between the examined groups was proved, and stress, personal and emotional structures of parasuicide were confirmed by discrimination analysis. Auto-destructivity shows even quicker forms of destruction and longer forms of self-destruction.

Dementia paralytica (neurosyphilis): a clinical case study.

This study reminds clinicians that syphilis presents in many guises. Wars, migration and sexual promiscuity prepare the ground for its return as an important cause of neurological and psychiatric syndromes. Our patient's diagnosis was not suspected at earlier admission. Stage III spirochaetosis was improved by high dose penicillin.

[Suicidal and parasuicidal behaviour]. / Suicidalno i parasuicidalno ponasanje.

UNLABELLED: Subject of the study is suicidal and parasuicidal behaviour in B&H in the period 1992-2004 in relation to transition, anomie and structures of suicidal personalities. METHOD: Two self-destructive groups (in 2001 and in 2005) were tested in B&H. The test group consists of n = 125 subjects who had suicide, and control group consists of n = 125 persons with parasuicidal behaviour. WE USED: GDL, EPQ, HAMD and Pluchic's test in a longitudinal study stratified by the seriousness of suicide and quality of parasuicide. RESULTS: Self-destructivity has been increasing in B&H. Socio-demographic data of the suicide are: gender = 73.3 +/- 2.5 (m) 26.7 +/- 2.7 (f), broken family = 34.4 +/- 4.8, migration = 52.2 +/- 3.2, heredity = 46.7 +/- 2.0 and parasuicide: gender = 47.8% +/- 5.2(m), 26.7 +/- 2.7(f), broken family = 41.1% +/- 5.2, migration = 54.4% +/- 4.6, heredity = 41.3 +/- 2.8. EPQ in suicide is: M +/- SD--neuroticism = 16,73 +/- 7.03, psychosis = 18,21 +/- 6.64, and in parasuicide extroversion = 15,37 +/- 4.21 and Lay-scale = 13,95 +/- 3.37, and significance p<0.01. HAMD is increased in suicide: H +/- SD: depression: 2.99 +/- 1.21, emotion of guilt = 2.19 +/- 1.14, suicide = 3.91 +/- 1.19, early insomnia = 2.11 +/- 1.21, anxiety = 1.93 +/- 1.21 with p<0.01, and in parasuicide: hypochondria = 1.77 +/- 0.95, depersonalization = 1.71 +/- 0.65, and O-K-signs = 1.59 +/- 0.79 with p<0.01. Pluchic's test separates basic emotions, and all is gathered by matrix of discriminative function. CONCLUSION: High level of self-destruction in suicidal and parasuicidal behaviour is proven in the study. Suicide shows faster self-destruction and a way of suicidal end, and parasuicide slower destruction with postponing the suicidal crash. Sign of suicide and parasuicide can be found in both groups of respondents and the ways of expression are different, but definite in suicide.