Treatment in Psychiatry in a New Classification Attire in the Shadow of Silence and Unprocessed Traumas from the Past. The Imperative of Perfectionism in the Present and Shame and Discomfort in the Future.

The new classification systems in psychiatry have dressed both patients and psychiatrists in completely new attire. One (DSM -5) is widely used and critics are hardly at peace with the psychiatry of normal living conditions and phenomena and a missed opportunity to 'save the normal'. The second attire is still standing on the mold in tailoring salon in Geneva (ICD-11) and is being ornamented by the online testing through a global network of clinical practice, now around 15,000 clinicians and mental health professionals, before it is distributed to psychiatrists worldwide. The objective is to (be) treated better and to keep quiet. We remain silent for fear, shame and insecurity in the face of devastating tendencies in the modern world. Unprocessed traumas and mourning from the past in current global setting support various mental disorders. Trauma leaves strong emotions, so if it has not been processed and the loss has not been mourned, these charged emotions get the characteristics of emotional volcanoes or timed bombs that are easily activated. Unprocessed group trauma among political or ideological leaders can become a means of strong manipulation of the masses. And the 'masses' are immersed, globally, in the mentalization of cognitive achievement at the expense of the emotional principle. By forcing competitiveness, perfectionism and narcissism, people try to 'be successful' at all costs. Perfectionism is a phenomenon that, under the influence of scientific and technological progress, computerization and globalization, increasingly affects the psychosocial development, functioning of the individual and society as a whole. Perfectionism is increasingly associated with anxiety and affective disorders, obsessive-compulsive disorders, eating disorders, and suicidality. Virtual reality, virtual sexuality, pornography, pervasive alienation and loneliness create a position of shame and cultural discomfort, which is so far the price of conformism. But in the Manichean prism, we might also call the new age an era of shamelessness and perversion in the broader sociocultural context leaving open the key question: "Can modern civilization avoid self-destruction?"

Psychiatry between Glorification and Stigmatization.

In psychiatry, stigma means negative marking of the person only because s(he) has a diagnosis of mental disease, and usually this refers to schizophrenia. Stigmatization is related to prejudice, i.e. negative attitudes that are deeply rooted on false beliefs that schizophrenia cannot be treated. In principle, stigma is caused by combination of ignorance and fear which represents the basis of the creation of entrenched myths and prejudice. From a historical point of view, schizophrenia as a disease remains for public, one of the medical areas that are related to fear, a sense of discomfort, prejudice and avoidance. A combination of difficult mental disease, discrimination and stigmatization can be devastating for mentally disabled patients. Throughout history, stigma played significant role in patient's emotional and social isolation from other people deepening their suffering. A common consequence of stigma is discrimination which represents violation of basic human rights. Mentally disabled patients are often unjustifiably seen as dangerous, incapable, irresponsible which causes their isolation, homelessness and economic collapse. Thereby, possibilities for normal life, work, treatment, rehabilitation and social integration are decreased.

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.

Aggression in war veterans suffering from posttraumatic stress disorder with co-morbid alcoholism.

For thousands of years it has been known that aggression as a symptom appears in numerous psychiatric disorders and diseases. During the last decade the appearance of the aggressive behavior related to the posttraumatic stress disorder (PTSD) has been frequently investigated, often associated with war trauma. The goal of this study is to analyze the impact of alcoholism on a way war veterans suffering from chronic PTSD express and control aggression. The sample included 240 war veterans with chronic PTSD. The subjects were divided in two groups. PTSD group (n=147) and controlled group composed of those suffering from alcoholism in addition to PTSD (n=93). In this study, the following psychological instruments were used: The Harvard trauma questionnaire for PTSD diagnosis (HTQ); the questionnaire for self-evaluation of aggression (STAXI); The Profile Index Emotion (PIE); questionnaire for auto-diagnosis of alcoholism (CAGE). The obtained results indicate that subjects who have PTSD with co-morbid alcoholism are more deprived, aggressive (p < 0.001) and oppositional (p < 0.05) in comparison to subjects whose PTSD is not combined with alcoholism (PIE). The aggression is statistically more expressed in subjects with PTSD who have also been diagnosed with alcoholism on all subscales in comparison to subjects with PTDS who have not been diagnosed with alcoholism: the current state of aggression, the general state of aggression, aggression towards an unfair treatment, aggression directed inwards and outwards (p < 0.001); aggression towards nonspecific provocation and a general way of expressing aggression (p < 0.05) (STAXI). Subjects that had PTSD combined with alcoholism show a higher degree of aggression in comparison to subjects with PTDS who are not diagnosed with alcoholism.

[Impact of the family socioeconomic status on health related quality of life in children operated on for congenital heart defects]. / Povezanost socijalnoekonomskog stanja obitelji i kvaliteta zivota djece nakon operacije urodene anomalije srca.

OBJECTIVE: The aim of the study was to assess the impact of the family socioeconomic status (SES) on health related quality of life (HRQoL) in children operated on for congenital heart defects. PATIENTS AND METHODS: The study included 114 children aged 1.6-18 (mean = 10.2 +/- 4.2) years (46.5% male and 53.5% female), followed up at University Department of Pediatrics in Tuzla after cardiac surgery, and one of their parents or caretakers. Of 114 children with congenital heart defects, 54.4% had anomalies with left-right shunt, 18.4% obstructive type anomalies and 27.2% complex anomalies. Control group consisted of 127 healthy age-matched subjects (age range 1.5-18, mean = 11.2 +/- 4.2 years; 49.6% male and 50.4% female). In this prospective study, we used PedsQL 4.0 Generic Core Scale to assess HRQoL of children operated on for congenital heart defects. This measurement includes both the parent proxy and child reports. The family SES was assessed by use of Hollingshead two factor index of social position. Statistical significance of differences between respondents and control group was determined by use of t-test and ANOVA with Bonferroni test. RESULTS: The reports of children operated on for congenital heart defects yielded no statistically significant difference in their HRQoL according to family SES. Parental proxy reports showed medium scores for physical health and activity to be significantly lower in children from low SES families as compared with those from medium SES families. Scores on school activities also differed significantly between patients with low and higher family SES. Parental reports revealed statistically significantly poorer HRQoL in children from low SES families in terms of physical health and activity, psychosocial and emotional health and social activities scores, as compared with the control group with low SES. Children operated on for congenital heart defects from medium and high SES families also had statistically lower school activities in comparison to control group of children from medium or high SES families. CONCLUSION: The results of HRQoL according to parental proxy report indicated low SES to influence various aspects of HRQoL in children operated on for congenital heart defects. This could be explained by the fact that the risk factors associated with low SES may directly or indirectly affect not only family HRQoL but also HRQoL of children operated on for congenital heart defects. Therefore, it appears necessary for the low SES families with a child suffering from chronic disease to receive help from wider community to solve the above mentioned problem.

Post-war mental health promotion in Bosnia-Herzegovina.

After the war in Bosnia-Herzegovina, mental illness is very prevalent. With little knowledge about mental health, the stigma of mental illness is still pervasive in many communities. To combat this prejudice, we describe mental health promotion strategies which can empower individuals and educate the communities in which they live.

The organisation of mental health services in post-war Bosnia and Herzegovina.

Bosnia and Herzegovina (BH) is located on the western part of the Balkan Peninsula. It has an area of 51 210 km2 and a population of 3 972 000. According to the Dayton Agreement of November 1995, which ended the 1992-95 war, BH comprises two 'entities' - the Federation of Bosnia and Herzegovina (FBH) and the Republic of Srpska (RS) - and the District of Brcko. The administrative arrangements for the management and financing of mental health services reflect this. The FBH, with 2 325 018 residents, is a federation of 10 cantons, which have equal rights and responsibilities. The RS has 1 487 785 residents and, in contrast, a centralised administration. Brcko District has just under 80 000 residents.