Outcome of influenza vaccination in combat-related post-traumatic stress disorder (PTSD) patients.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur after exposure to extreme traumatic experience such as war trauma, and is accompanied by fear, helplessness or horror. Exposure to trauma can result in immune dysregulation and influence susceptibility to infectious disease as well as vaccine efficacy. The aim of the study was to determine the relation of psychological stress and the immune response to influenza vaccination in combat-related PTSD patients (n = 28). Detection of anti-viral antibody titre was performed by inhibition of haemagglutination assay. Ex vivo tetramer staining of CD8(+) T lymphocytes was used to monitor T cells specific for human leucocyte antigen (HLA)-A*0201-restricted influenza A haemagglutinin antigens before and after vaccination. Twenty patients showed a fourfold antibody titre increase to one or both influenza A viral strains, and 18 of them showed the same response for both influenza B viral strains. Ten of 15 healthy controls showed a fourfold rise in antibody titre to both influenza A viral strains and eight of them showed the same response for both influenza B viral strains. HLA-A*0201(+) PTSD patients (n = 10) showed a significant increase of influenza-specific CD8 T cells after vaccination. Although those PTSD patients had a lower number of influenza-specific CD8(+) T cells before vaccination compared to HLA-A*0201(+) healthy controls (n = 6), there was no difference in influenza A antibody titre between PTSD patients and control subjects before vaccination. The generated humoral and cellular immune response in PTSD patients argues against the hypothesis that combat-related PTSD in war veterans might affect protection following influenza vaccination.

Catatonic schizophrenia has a shorter pre-hospitalisation interval than other types of schizophrenia.

The time elapsed between the first onset of symptoms and the onset of first hospitalisation was analysed in 355 participants diagnosed with paranoid, simple, hebephrenic and catatonic schizophrenia and shizoaffective disorder. The real onset of the disease was assessed from interviews with reliable relatives and by reviewing medical records in general practices and out-patient psychiatric services. In 184 patients a family history of schizophrenia was identified. A positive family history was found to significantly increase the interval preceding first hospitalisation in all analysed types, except in catatonic schizophrenia. Possible reasons causing this prolongation are discussed, as well as repercussions of the results to studies using age of first hospitalisation as the leading indicator.

Stressor characteristics and post-traumatic stress disorder symptom dimensions in war victims.

AIM: To evaluate how the type of trauma is related to specific symptom patterns in patients with post-traumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria. METHODS: A total of 136 PTSD patients exposed to war-related traumatic experiences were divided in four groups: 79 veterans, 18 former prisoners (who witnessed or were subject to torture or frequent assaults), 15 victims of rape, and 24 refugees from Bosnia and Herzegovina. Each group was homogenous in regard to traumatic experiences. RESULTS: Significant inter-group differences were found in symptoms listed in the DSM-IV criteria, and under criteria C (avoidance) and D (arousal). No such differences were observed in symptoms listed under criterion B (intrusive symptoms). The results indicate that stressor characteristics may play a role not only in the variety of symptoms exhibited, but particularly in the number of avoidance and arousal symptoms. Victims of rape tended to present with more avoidance symptoms and fewer hyperarousal symptoms, whereas former prisoners and veterans tended to report more hyperarousal symptoms. Rape victims and former prisoners also reported more symptoms than the other groups. CONCLUSION: There is a strong indication that stressor characteristics influence the variety and number of exhibited intrusive, avoidance, and arousal symptoms. More research is needed to precisely define individual symptom dimensions possibly relating to particular stressor characteristics. Additional studies are needed to determine whether PTSD, as it is currently defined in the DSM-IV, is really a homogenous diagnostic category.

Catatonic schizophrenia in Croatia.

A representative sample of schizophrenic subjects was collected for epidemiological and clinical follow-up in 1972 from the pool of 8069 patients registered in the Croatian Psychotics Case Register (CPCR). This sample comprised 402 patients (207 males and 195 females), who were followed up until 1990/91. The diagnosis of schizophrenia, catatonic type according to ICD-8 (V/295.2), was made in 59 cases (14.7%; 28 males, 31 females) at least once in the course of the follow-up. This study presents data concerning the diagnostic instability of the catatonic subtype during the long-term follow-up. As subtype diagnoses were frequently changed over the course of illness, at the end of the follow-up, the diagnosis of catatonic schizophrenia was only confirmed in 11 (18.6%) cases. Positive family history of psychosis was found in 44.1% of catatonic patients, a percent significantly greater than the corresponding figure for all non-catatonic schizophrenic subtypes combined (20.1%). This study provides preliminary evidence that the catatonic subtype of schizophrenia is a separate diagnostic entity with a high familial loading.

Physiological characteristics of platelet/circulatory serotonin: study on a large human population.

The aim of this work was the study of platelet/circulatory serotonin (5-hydroxytryptamine, 5-HT), specifically alternative ways of its measurement and main physiological characteristics. The study was performed on a large human population (N=500) of blood donors of both sexes over the course of a longer time period (17 months). Owing to the heterogeneity in measurement of circulatory serotonin encountered in the literature, three ways of expression were comparatively studied: per unit number of platelets, per unit mass of platelet protein and per unit volume of whole blood. Results demonstrated unimodal distribution of individual frequencies of platelet/circulatory serotonin in the human population with the mean values of 579+/-169 ng 5-HT/10(9) platelets; 332+/-89.9 ng 5-HT/mg protein and 130+/-42.3 ng 5-HT/ml blood (mean+/-S.D.). A progressive decrease of serotonin level with age (18-65 years) was demonstrated, reaching statistical significance between the extreme age groups. No significant differences in the serotonin level between the sexes were observed. No seasonal oscillations in platelet/circulatory serotonin were found. Platelet serotonin demonstrated intra-individual stability over time. Finally, regarding the methodology of measurement, our results demonstrated a good correlation among the above-mentioned ways of expression of platelet/circulatory serotonin. This indicates the possibility of intercomparison of the literature reports expressing this physiological parameter either as 5-HT concentration in platelets or as 5-HT level in the circulation.

Posttraumatic stress disorder and platelet serotonin measures.

The role of serotonin (5HT) in the pathophysiology of posttraumatic stress disorder (PTSD) has been suggested by the overlap in clinical symptoms between PTSD and psychiatric conditions in which a serotonin dysfunction is implicated, as well as by the therapeutic efficiency of 5HT-related drugs (antidepressants, selective serotonin reuptake inhibitors and monoamine oxidase inhibitors) in alleviating symptoms in PTSD. In the present study, the blood platelet, which has been proposed as a peripheral model for the central serotonergic neurons, has been used to search for alterations in 5HT mechanisms in PTSD. Platelet serotonin level and kinetics of serotonin transporter and monoamine oxidase (MAO-B) were assessed in 63 combat-related PTSD patients and 43 sex and age-matched control subjects. A significant reduction in maximal velocity of platelet MAO-B (approx. 30%), with no changes in the enzyme affinity was observed in our patient sample. Conversely, no alterations in kinetic parameters (V(max), K(m)) of platelet serotonin transporter, as well as in platelet 5HT level, were found in the PTSD group.

A 12-month, randomized, placebo-controlled trial of propentofylline (HWA 285) in patients with dementia according to DSM III-R. The European Propentofylline Study Group.

Alzheimer's disease (AD) and vascular dementia (VaD) share several features such as overactivation of microglial cells, damage induced by free radicals, glutamate and calcium overload. Propentofylline (HWA 285) has shown beneficial effects on all of these common elements, thus favouring its use in both subtypes of dementia. In a multinational, randomized, 12-month, double-blind, parallel-group study 260 out-patients with mild to moderate AD or VaD received 300 mg propentofylline (n = 129) or placebo (n = 131) three times daily 1 h before meals. The efficacy was tested at four independent rater levels (physician, psychologist, relative and patient) with assessments covering three major domains of dementia (global function, cognitive function and activities of daily living). After 12 months, the total patient population showed statistically significant treatment differences in favour of propentofylline for the global measures of dementia (Gottfries-Bråne-Steen scale, GBS, p = 0.001; Clinical Global Impressions, CGI, item I: p = 0.004, item II: p = 0.072) as well as for the cognitive measures (Syndrome Short Test, SKT, p = 0.002) and Mini-Mental State Examination (p = 0.001). The activities of daily living also showed a significant treatment difference in favour of propentofylline (p = 0.002). No significant treatment differences were found for rating scales performed by the patients. At month 12, VaD patients showed treatment differences in favour of propentofylline for the GBS total score (p = 0.006), CGI item I (p = 0.004), GGI item II (p = 0.044) and SKT (p = 0.028). Treatment differences for AD patients were all in favour of propentofylline and reached statistical significance for the SKT (p = 0.018). Propentofylline showed a good safety profile with respect to adverse events, vital signs, ECG and laboratory changes.

Psychological condition hormone levels in war trauma.

Psychological and hormonal responses to various degrees of war-related traumatic experience were analysed in 91 subjects. Their psychological responses (psychosomatic, personality traits, etc.) were evaluated by the COR-NEX2 test. Based on test results, the subjects were classified into three groups: G1 = normal, G2 = moderate, and G3 = severe response. The distribution of subjects in the three groups was related to the intensity and duration of stress that they had been exposed to. Serum levels of cortisol, prolactin, beta-endorphin, thyroxin and triiodothyronine were analysed in all subjects. The levels of cortisol and prolactin were significantly decreased in subjects expressing a severe psychological response, while the level of prolactin correlated with COR-NEX2 test scores. Although relations to other intervening variables are to be investigated, our results indicated that endocrine changes, following trauma, were not random, but rather related to stress-induced psychological responses, and not to trauma per se.

Influence of alcoholism on the prognosis of schizophrenic patients.

OBJECTIVE: This study was undertaken to investigate possible differences in clinical, social and hospital prognosis in schizophrenics with or without codiagnosed alcoholism. METHOD: A representative sample was selected by a two-stage random sample of sets from the total of 10,569 schizophrenic patients registered in the Croatian Psychotic Case Register in the period 1962-71. The resulting 449 schizophrenic patients were psychiatrically examined in 1973-75 wherever they were found--at home, in a hospital or in a social-health institution. Of these original patients, 312 with or without a dual diagnosis of schizophrenia and alcoholism who were found at home were followed up until the final examination in 1990-91. RESULTS: Rate changes in 37 patients with the dual diagnosis were significant in the following characteristics: they were more often men, married, with a paranoid-hallucinatory disease form, were aggressive during examination, and were without psychiatric aftercare or regular psychopharmacotherapy (p < .01); they came from rural areas, had a mixed clinical picture with a deteriorating disease course and were less communicative and socially functional, and were without work self-initiative and personal income (p < .05). CONCLUSIONS: Schizophrenic patients found at home with codiagnosed alcoholism have poorer clinical, hospital, social and life prognosis and need longer hospitalization. They represent a special subgroup of schizophrenics requiring special therapeutic approach and early identification, inasmuch as their course of the disease has a tendency toward rapid deterioration. Prevention of alcoholism and its adequate treatment have far reaching implications for the prognosis of schizophrenic illness.

Rape, torture, and traumatization of Bosnian and Croatian women: psychological sequelae.

The first 25 Bosnian women admitted to the Zagreb Obstetrics and Gynaecological Clinic or its associated regional psychiatric centers were assessed using both clinical and post-traumatic stress disorder interviews. Most of the women had been multiply traumatized; all had been repeatedly raped. Psychological status was assessed for those women who were not impregnated, for those impregnated who received abortions, and for those impregnated who carried the fetus to term.

Schizophrenia in Croatia: age of onset differences between males and females.

The age of disease onset, the age at first admission and the age of first admission with a schizophrenia diagnosis were determined in a sample of 679 patients (356 males and 323 females) representing 8069 schizophrenics hospitalized in Croatia in the 1962-1971 period and followed up in an epidemiologic field study until 1991. Male and female patients were not found to differ significantly either in the average age of schizophrenia onset or age at first admission. In the majority of females the disease started at a slightly earlier age than in males, which might be due to the general biological and psychosocial differences between males and females. The age of females at first admission with a schizophrenia diagnosis was significantly higher than that of males. The differences between the schizophrenic males and females in the length of the preadmission period and diagnostic process, as well as in mortality, may contribute cumulatively to the recording of onset for female schizophrenics at a higher age in comparison to male schizophrenics.

Schizophrenia and prenatal exposure to the 1957 A2 influenza epidemic in Croatia.

The authors present data from the Republic of Croatia on schizophrenia rates in a birth cohort prenatally exposed to the 1957 A2 influenza epidemic and in comparison (unexposed) birth cohorts. The rate of schizophrenia did not differ significantly between the exposed and unexposed cohorts.

Schizophrenia in Croatia: interregional differences in prevalence and a comment on constant incidence.

STUDY OBJECTIVE: The aim was to examine why differences exist in schizophrenia prevalence and risk in some areas of Croatia, when schizophrenia incidence rates do not appear to vary. DESIGN: Areas differing by schizophrenia admission rates in patients born in 1953 and admitted by the age of 31 years are compared using a number of indicators relating both to general population characteristics and to those of schizophrenic cases in these populations. SETTING: The study covers the whole of Croatia (4,601,469 inhabitants, 1981 census). SUBJECTS: By the age of 31 years, out of 80,445 individuals born in Croatia in 1953, 464 were admitted for and diagnosed as having schizophrenia. MAIN RESULTS: Admission risk rates are higher in those parts of Croatia where emigration rates are high and lower where immigration rates are high. There is also a positive correlation with schizophrenia prevalence and manic depressive psychosis rates. There is a negative correlation with age of onset of schizophrenia and with schizophrenic reproduction rates. In the study areas, hospital incidence rates are not significantly different. CONCLUSIONS: Economic migration and negative selection in the domestic population are likely to be the most significant factors leading to differences in schizophrenia prevalence. The approximately equal incidence rates in the population, with different prevalence and admission risks, are linked to differences in the disease onset among schizophrenics with a positive family history for this condition. In other words, these patients, when part of the population with a greater prevalence and a greater hereditary loading, experience the onset more often at an earlier age. Thus they have a lower reproduction rate than in a population with a lower prevalence and a lower hereditary loading. Thus incidence rates in populations with different prevalences and different hereditary loads are maintained roughly equal over generations.

Rating scales and computed tomography in multi-infarct dementia.

Forty patients who fulfilled the DSM-III-R criteria for multi-infarct dementia and had a score of 7 points or more on Hachinski ischemia score (HIS) were analyzed with the purpose to correlate the rating scales and CT scans. Among the examined patients there were 32 women with the average age of 68.5 +/- 9.8 years and 8 men with the average age of 68.8 +/- 10.4 years. No significant difference between sex in relation to Folstein Mini-mental state examination (MMSE), Gottfries-Brane-Steen scale (GBS) and Sandoz clinical assessment-geriatric scale (SCAG) was found. There is no correlation of GBS and SCAG on MMSE. With regression analysis a good correlation was found between GBS and SCAG, and we suggest that in such studies only one of these two scales is sufficient. CT abnormalities were found in about 77% of examined patients without difference according to sex. But, GBS score demonstrated greater disability among MID patients with abnormal CT scans than in MID patients with normal CT scans. In medical history of male MID patients completed stroke was significantly more common than among women, while the female MID patients had in their history significantly more frequent transient ischemic attack (TIA). This finding should be checked in a greater patient population. It is stressed that in everyday clinical practice it is necessary to use the diagnosis of multi-infarct dementia, e.g. to differentiate cerebral diseases according to etiology and pathogenesis.

[Work at the Department of Psychiatry and Psychology at the Medical Headquarters of the Republic of Croatia]. / Rad odjela za psihijatriju i psihologiju pri Glavnom stozeru saniteta Republike Hrvatske.

During the summer 1991, the Ward of Psychiatry and Psychology at the Medical Headquarters, Republic of Croatia has been established as a direct reaction to the cruel war in Croatia. The aim of the Ward is to prevent mental disorders among the individuals participating in the war and among the population of Croatia. Special attention is given to the threatened groups. These are: injured patients, displaced persons, children who have lost one or both of its parents, members of families of persons who have been killed or injured and the others. Treatment doctrines have been provided as well. Besides, a regional psychiatric service which has been formed in accordance with the characteristics of this war which is carried out without a known front, mobile psychiatric groups have also been established. They are made up of volunteers. Particular attention has been directed toward the education and publishing. The first Croatian war psychiatry entitled "Introduction into the War Psychiatry" is going to be published very soon. A program of the so-called veterans hospital has been worked out as well.

Vitamin C status in chronic schizophrenia.

Schizophrenic patients on the same hospital diet as control group subjects had significantly lower levels of fasting plasma vitamin C (p less than 0.05) and 6-hr urinary vitamin C excretion after an ascorbic acid load test (p less than 0.01). After administration of 70 mg of ascorbic acid for 4 weeks there was no longer any difference in plasma vitamin C levels between schizophrenics and control group subjects, but the urinary vitamin C excretion after the vitamin C loading test remained significantly lower in schizophrenics (p less than 0.05). The administration of 1 g ascorbic acid for 4 weeks, in addition to eliminating differences in the plasma vitamin C level, also increased the urinary vitamin C excretion of schizophrenic patients to the level of the control group subjects. The results of this study are in agreement with the hypothesis that schizophrenic patients require higher levels of vitamin C than the suggested optimal ascorbic acid requirement for healthy humans.

[The role of professional personnel in the length of hospitalization of psychiatric patients]. / Uloga strucnih kadrova u trajanju hospitalnog lijecenja psihijatrijskih bolesnika.

In this paper the qualified personnel turnover within the 25 years is presented. The following data are used: statistical data of the Psychiatric Hospital Vrapce, Zagreb, the data of Psychotic Register of the Socialistic Republic of Croatia and specially taken poll in greater psychiatric hospitals in Croatia. In order to follow the situation in psychiatric organizing scheme, particular indicators are used. In the treatment evaluation, the personnel is measured according to the number of discharged or treated patients. The changes within period of a quarter of a century in psychiatry relating to the role, number and kind of staff who participate in psychiatric patients treatment, can be summarized as significant (high) rise of the psychiatrists, certain oscillations in the number of professional associates (psychologists, social workers, special teachers and other therapists) with the tendency to increase (although still insufficient), the growth of a number of nurses slight oscillations of the number of beds with minor diminishing during the last years, inpatients number increase, changes of diagnostic structure of inpatients and significant shortening of the hospitalization period of all the psychiatric patients. The increase of the number of psychiatrists is the most important in prognosis of the inpatients treatment directly referring to the shortening of the hospitalization period and the increase of the number of discharged patients (which is generally 80-100 discharged patients annually per psychiatrist).