Similarities in the pattern of regional brain dysfunction in negative schizophrenia and unipolar depression: a single photon emission-computed tomography and auditory evoked potentials study.

1. Negative schizophrenic and unipolar depressive patients were clinically assessed. In addition to this SANS and HRSD tests were administered. 2. SPECT and AEP measurements were provided. SPECT resulted in quantified brain blood perfusion, by means of average "count/pixel" values in the brain regions of interest. AEPs resulted in stored multichannel signal waveforms. 3. Statistical analyses of blood perfusion measurement data revealed an overall similarity between these two disorders in the majority of brain regions. An exception to this are the regions: inferior temporalis, inferior occipitalis, hippocampus and the anterior basal ganglia. Both diagnostic groups manifested hypofrontality. In general, hypoperfusion of the left hemisphere was found, albeit displaying different patterns in the two groups investigated. 4. AEP latencies were prolonged and found to be similar in both diagnostic groups, whilst AEP amplitudes were smaller in schizophrenics compared to depressives.

Electroencephalographic comparison of veterans with combat-related post-traumatic stress disorder and healthy subjects.

Various investigations prove the biological basis for post-traumatic stress disorder (PTSD). There are only a few quantitative electroencephalographic (qEEG) studies of patients with PTSD. The aim of this investigation is to find out whether there are differences in qEEG parameters between PTSD patients and healthy subjects. The experimental group was comprised of 18 veterans with PTSD, and 20 healthy non-veterans were included in the control group. After informed consent was obtained, they were investigated by qEEG recordings. The artifact-free EEG epoch was analyzed by fast Fourier transformation (FFT). Power values of particular frequency bands (delta, theta, alpha 1, alpha 2, beta 1, beta 2) were observed on the regions: Fp I, Fp2, F3, F4, F7, F8, C3, C4, T3, T4, T5, T6, P3, P4, O1 and O2. PTSD patients had increased theta activity over central regions, and increased beta activity. Beta 1 activity increased over frontal, central and left occipital regions; beta 2 activity increased over frontal regions. No significant differences were noted between the PTSD and control group in delta and alpha activity. These results suggest a neurobiological basis for PTSD. Increased theta activity may help to explain changes in hippocampal volume. Various explanations (cortical hyperexcitability, prolonged wakefulness, or attention disturbances) have been offered for the beta activity increase observed in PTSD subjects.

Drug use among Croatian students.

The subject of this study was to determine the frequency of drug use and attitudes toward drug use in Croatian high school students. The study was carried out in a middle-class high school in Zagreb. Out of 273 students who participated in an anonymous, self-report, 23-item questionnaire, 69 reported that they had at least once used drugs. The most frequently used drug was cannabis. While one third of students have been offered drugs, even 41% of the students would have take the drug if it becomes available. It can be concluded that the drugs appear to be highly available among Croatian students. According to our results, even more stronger increase in the number of drug users in Croatia could be expected.

The potential role of hypocortisolism in the pathophysiology of PTSD and psoriasis.

Different physical, chemical and psychological stressors can provoke a unique but different endocrine response involving activation of the hypothalamo-pituitary-adrenal (HPA) axis. Inability of adequate compensatory reaction can lead to many disorders. The aim of our study was comparison of cortisol values in diseases provoked by various stressors. Our investigation included 34 posttraumatic stress disorder (PTSD) patients, as an example of disorder caused by extremely strong, acute stressful stimulus, 19 psoriatic patients, as an example of chronic stress stimulus and 17 healthy volunteers. In each patient we determined 24-hour urinary cortisol, serum cortisol at 8 a.m. and 5 p.m., and cortisol in dexamethasone suppression test by the standard radioimmunoassay (RIA) method. PTSD patients showed lower urinary 24-hour cortisol values, (361 +/- 28 nmol/24 h), "stronger" circadian rhythm of serum cortisol (595 +/- 57 nmol/l at 8 a.m. and 242 +/- 23 nmol/l at 5 p.m.) and attenuated suppression of cortisol in dexamethasone suppression test (197 +/- 45 nmol/l) in comparison to healthy volunteers (590 +/- 87 nmol/24 h urine, 590 +/- 32 nmol/l at 8 a.m., 402 +/- 31 nmol/l, and < 86 nmol/l in dexa test). Psoriatic patients showed markedly lower 24-hour cortisol values (150 +/- 98 nmol/24 h), even in comparison to PTSD patients, then serum cortisol values (404 +/- 138 nmol/l at 8 a.m., 187 +/- 80 nmol/l at 5 p.m.) and enhanced suppression of cortisol (23 +/- 5 nmol/l). The model of attenuated feedback inhibition in PTSD patients shows that they are unusually reactive to stress and represents an alternative model of acute stress reaction to extremely strong stressful stimulus. Unusually low cortisol values in psoriatic patients correlate to our hypothesis that in chronic stress-related disease, as psoriasis is, exists, by still undefined mechanism, altered HPA axis function, which is obviously incompetent to realise its immunoregulatory function, so consequentially, clinical signs of psoriasis persist.

[Psychiatric disorders in war and other catastrophic circumstances-- posttraumatic stress disorder]. / Psihijatrijski poremecaji u ratnim i drugim katastroficnim prilikama--posttraumatski stresni poremecaj.

The paper presents mental disorders occurring in people as a consequence of facing extraordinary situations of mental stress which surpass common human experience and are very frequent in war circumstances. Since 1980 all similar conditions have been classified as a single entity called Post-Traumatic Stress Disorder (PTSD). The disorder may occur immediately after the traumatic experience (acute form), or several months and even years later (chronic, delayed form). The etiology and therapy of the PTSD is discussed.

[Delusional misidentification syndromes]. / Sumanuti sindromi pogresnog prepoznavanja.

According to ICD-10 and DSM-IV classifications, delusional misidentification syndromes are a specific subgroup of unspecified persistent delusional disorders. They are characterized by systematic incorrect identification and the basic delusional idea--the concept of a double, illusion of a double. The authors present the most frequent delusional misidentification syndromes, and the most frequent elements of the clinical picture and etiological hypotheses. Because of their small frequency and the basic characteristics of these syndromes to appear mostly as a part of some other disturbance, the authors emphasize the importance of a careful differential diagnostic procedure, which has therapeutic implications.

[Case report of a female patient in a state of catatonic excitement]. / Prikaz bolesnice u stanju katatonog uzbudenja.

A female patient in a state of catatonic excitement, with strongly manifested self-destructive impulses is presented. Catatonic excitement is rather infrequent in today's clinical practice. Therefore, the paper describes the clinical course, diagnostic procedures, and therapy. Various clinical states are discussed, in which this type of disorder occurs, with an emphasis on the need for a team work.

[Anorexia nervosa]. / Anoreksija nervoza.

Anorexia nervosa is a very serious and potentially lethal eating disorder. It is characterized by distorted body picture, obsession with thinness, and loss of body weight exceeding 15% of expected ideal body weight. The incidence of this disorder is increased and the earlier the diagnosis and therapy start, the better is the prognosis. Etiology is unknown, but biological, social and psychological factors are assumed. The clinical picture is characterized by loss of body weight, amenorrhea, opstipation, sensitivity to cold, dry skin, exhaustion and obsession with the fear of becoming fat. Some laboratory findings are deranged, especially electrolyte balance. Hormonal derangement is also found. Diagnosis is made according to ICD 10, or DSM IV diagnostic criteria. In differential diagnosis, distinction has to be made from many somatic and some psychiatric disorders. Generally, somatic complications indicate the treatment, first in hospital and later on the outpatient basis. In the treatment, special attention should be paid to simultaneous application of pharmacotherapy and psychotherapy in order to ensure better prognosis, which is usually poor.

Psychiatry in selected countries of Central and Eastern Europe: an overview of the current situation.

OBJECTIVE: To review the current status of psychiatry in selected countries of Central and Eastern Europe: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Russia, Slovakia, and Slovenia. METHOD: A group of psychiatrists from the region evaluated the status of psychiatry at the end of 2004 based on data from their countries and information available on WHO homepages. RESULTS: There is a shift from traditional in-patient facilities towards out-patient and community services as evidenced by a decreasing number of hospital beds. Economic pressures affect the financing of psychiatric services, and reimbursement for novel psychotropics. Political changes were followed by updated legislation. Psychiatric training, pre-, postgraduate and continuous medical education, are gradually being transformed. Scientific output as measured by publications in peer-reviewed journals has been significantly lower than in the West. CONCLUSION: The major changes in the period of transition documented in the review pose new challenges for psychiatry.

Efficacy and safety of long-term risperidone treatment.

INTRODUCTION: While efficacy in treatment of the acute phase of schizophrenia is well established for so-called atypical antipsychotics, more data regarding long-term treatment are needed. METHOD: In a naturalistic, open-label study, 32 patients were included in order to investigate the efficacy and safety of risperidone over 3 years of treatment; 26 of them were treatment-resistant to the previously used antipsychotic drugs (except clozapine). RESULTS: At the end of the first year, 20 of these 26 patients showed at least partial improvement. At the end of the third year, 17 patients were still being treated with risperidone. While eight patients were lost to follow-up, six relapsed in spite of good compliance. All the adverse events which occurred during treatment were strictly dose-dependent and disappeared when the dose was lowered to 4 mg daily. CONCLUSIONS: Within the limits of naturalistic studies, it can be concluded that risperidone seemed to be an effective and safe drug for long-term treatment in the majority of our patients. (Int J Psych Clin Pract 2002; 6: 193-197 ).

Quantitative EEG in 'positive' and 'negative' schizophrenia.

OBJECTIVE: Quantitative EEG has yielded different results in schizophrenia. The method of quantitative EEG has been relatively poorly used in the studies of the dichotomy into positive and negative schizophrenia. METHOD: Amplitude values of any particular frequency band (after fast Fourier transformation, FFT) were observed in 47 schizophrenic patients (25 patients with positive and 22 patients with negative schizophrenia) and in 50 normal subjects. The frontal, temporal, parietal and occipital regions (F3, F4, C3, C4, T3, T4, P3, P4, O1 and O2) were observed. RESULTS: Positive and negative schizophrenia were found to differ only in the delta and theta bands over frontal regions. Positive and negative schizophrenic patients were found to differ from normal subjects in delta, theta, alpha and beta 2 bands. CONCLUSION: Delta and theta activity may play a role as a marker in differentiating between positive and negative schizophrenia.

Quantitative EEG in schizophrenic patients before and during pharmacotherapy.

The aim of the study was to determine the possible differences in quantitative EEG parameters of schizophrenic patients before and during therapy with neuroleptics. First EEG recordings were obtained from schizophrenic patients (n = 50) who had not been taking any medicaments during the preceding 2 months. Second EEG recordings were obtained during the administration of neuroleptic therapy. Amplitude values of particular spectral segment, i.e. delta, theta, alpha 1, alpha 2, beta 1 and beta 2 (after fast Fourier transformation) were analyzed. The F3, F4, C3, C4, T3, T4, P3, P4, O1 and O2 regions were observed. The effect of pharmacotherapy manifested as a decrease in delta and beta 2 activities. The alterations of the delta spectrum were recorded in each patient subgroup (regardless of the neuroleptic used). The changes in beta 2 activity were registered in patients on haloperidol and fluphenazine.

Verruculogen: a new substance for decreasing of GABA levels in CNS.

In our previous work we examined the mechanism of action of the new tremorogenic substance verruculogen isolated by Cole and coworkers. Examining the effect of various substances with known mechanisms of action on verruculogen-induced tremor, we concluded that this tremor was probably related to decrease of GABA levels in CNS. In order to further define the mechanisms of action of verruculogen, we determined brain GABA levels in animals in which tremor was produced by verruculogen administration. Verruculogen administration produced a decrease in GABA levels in mouse CNS. This finding substantiates our earlier suggestion that verruculogen-induced tremor is mediated by a loss of inhibitory GABA function.