Liraglutide 3.0 mg once daily for the treatment of overweight and obesity in patients hospitalised at a forensic psychiatric department: A 26-week open-label feasibility study.

INTRODUCTION: Overweight and obesity constitute a major concern among patients treated at forensic psychiatric departments. The present clinical feasibility study aimed at investigating the extent to which glucagon-like peptide 1 receptor agonist (GLP-1RA) treatment with once-daily liraglutide 3.0 mg could be a feasible pharmacological treatment of these conditions in patients with schizophrenia spectrum disorders hospitalised in forensic psychiatry. METHODS: The 26-week, open-label feasibility study included participants aged 18-65 years diagnosed with a severe mental illness and hospitalised at a forensic psychiatric department. At the time of inclusion, all participants fulfilled the indication for using liraglutide as a treatment for overweight and obesity. Participants' baseline examinations were followed by a 26-week treatment period with liraglutide injection once daily according to a fixed uptitration schedule of liraglutide, with a target dose of 3.0 mg. Each participant attended seven visits to evaluate the efficacy and adverse events. The primary endpoint was the number of "completers", with adherence defined as >80% injections obtained in the period, weeks 12-26. Determining whether liraglutide is a feasible treatment was pre-defined to a minimum of 75% completers. RESULTS: Twenty-four participants were included in the study. Sex, male = 19 (79.2%). Mean age: 42.3 [25th and 75th percentiles: 39.1; 48.4] years; body mass index (BMI): 35.7 [31.7; 37.5] kg/m2; glycated haemoglobin (HbA1c): 37 [35; 39] mmol/mol. Eleven out of 24 participants (46%) completed the study. For the completers, the median net body weight loss after 26 weeks of participation was -11.4 kg [-15.4; -5.9]. The net difference in HbA1C and BMI was -2.0 mmol/mol [-4; -1] and -3.6 kg/m2 [-4.7; -1.8], respectively. The weight change and reduction in HbA1c and BMI were all statistically significant from baseline. CONCLUSION: The study did not confirm our hypothesis that liraglutide is a feasible treatment for a minimum of 75% of the patients initiating treatment with liraglutide while hospitalised in a forensic psychiatric department. The high dropout rate may be due to the non-naturalistic setting of the clinical trial. For the proportion of patients compliant with the medication, liraglutide 3.0 mg was an efficient treatment for overweight.

Sense of Meaning of Life, Job Related Affective Wellbeing, Coping Strategies, Happiness, Self-Compassion, Perceived Stress and Depression/Anxiety in Middle-Aged Psychiatrists - A Case Series.

INTRODUCTION: Recent studies showed that physicians' well-being, happiness, and sense of meaning can easily be challenged and even threatened, while their coping mechanisms are often insufficient to prevent exhaustion and burnout. The aim of this case series is to assess these components; to see how they are interconnected and to compare results with previous studies. METHODS: Case series. The Meaning of Life Questionnaire (MLQ), the Job-related Affective Well-being Scale (JAWS), the Brief-COPE, the Subjective Happiness Scale (SHS), the Self-Compassion Scale (SCS-SF), the Perceived Stress Scale (PSS 10), the Depression Anxiety Stress Scale (DASS-10) are used. RESULTS: Results of self-reported questionnaires are shown. Individual results from a case report are compared with results from one previous research in the literature together with correlations between questionnaires from previous research. CONCLUSIONS: Physicians' timely awareness of their job-related wellbeing, perceived stress, happiness, depression and anxiety symptoms, self-compassion, and sense of meaning in life, together with their use of adaptive coping strategies can be useful for preventive purposes.

Personal wellbeing, work ability, satisfaction with life and work in psychiatrists who emigrated from Croatia.

BACKGROUND: A significant number of citizens, including a great proportion of doctors, both psychiatrists and doctors of other specialties, decided to emigrate from Croatia after Croatia entered the EU in 2013. Aim of research was to investigate possible differences in satisfaction with life and work between 3 groups: emigrants psychiatrists (EP), emigrants physicians of other specialties (E), and psychiatrists currently working in Croatia (C). SUBJECTS AND METHODS: Personal Wellbeing Index (PWI), Work Ability Index (WAI) and some qualitative research questions were used in an anonymous online survey which was conducted in autumn 2019. Link to the survey was shared on different social networks, while 138 physicians were approached directly by e-mail. Response rate: 87% for EP group (representative sample for group of psychiatrist emigrants from Croatia), 48% for E group, and 28% for C group. In total, 62 physicians, 44 of them emigrants (20 EP and 24 E). This study was voluntarily led. Psychiatrists from our sample emigrated mostly to Scandinavia in 65% of cases and to West Europe in 30% of the cases. Other physicians emigrants from our sample emigrated to Middle Europe in 29%, to West Europe in 25%, and to Scandinavia in 42% of the cases. RESULTS: Satisfaction with standard of life, future security and life achievements are significantly higher in EP than in C. Satisfaction with integration in community and satisfaction with close relationships are significantly higher in E than in EP. WAI score of the 3 groups placed them all in the same category "good work ability". For all emigrants and their family members, major challenges after emigration were found to be communication (language), integration into the community, and loss of friends and family connections. 70% of emigrants plan to return to Croatia in the future, depending on better living conditions (income), change in the political situation in Croatia (reduction of corruption), and change in people's mentality. CONCLUSIONS: This voluntary study showed high satisfaction with life and good work ability among psychiatrists who emigrated from Croatia, together with some challenges for them and their family members with language, work, integration into the community, and loss of friends and family connections. Majority plan to return to Croatia depending on political and economic changes in Croatia.

"Since I have my case manager, I am back to life" case management in Croatia.

The authors present a case report of a patient who was treated by a case manager, a member of a Croatian Community Mental Health (CMH) Team, following the recommendations of WHO 2004 as well as the IRIS guidelines and the Basic Standards for Management of Patients with Serious Mental Illness in the Community (Agius 2005) and using the elements of Clinical case management (Muser 1998), Assertive community treatment model (Burns 1995, Scott 1995, Wolfsan 1990), the personal strength model (Rapp 1988) and Rehabilitation model (Anthony 1993). In order to emphasize the importance of the therapist-patient relationship in the treatment of chronic schizophrenic patients (Ivezic 2001) and creating the group atmosphere a Croatian model of case management is created where the patient's needs and risks are assessed by a multidisciplinary team which also conducts the recommended psychosocial interventions plan. The majority of interventions are conducted in groups. The case manager develops a confident relationship with a patient, nourishes the positive transference and aids the delivery of the treatment. The main goals of the interventions are empowerment of the patient, improvement of his abilities and decreasing of disabilities. The case manager also carries out a full assessment of the needs of the patient's family so that the family or carers are also included in the treatment or support if necessary (Gruber 2006). A case report of a patient and the work of her case manager as well as the case manager's diary (Gruber 2007) and the Croatian model of case management is presented in this article.

"My new Alfa Romeo GT is not in the garage any more": Cognitive behavioural therapy of panic disorder with agoraphobia co morbid with psychosis.

This paper describes a case of co-morbid panic disorder and psychosis with a focus on the successful treatment of the panic disorder via a CBT approach. The patient has had only one episode of psychosis. The cognitive model of panic disorder is used as a template to consider this young man's psychotic experiences, in the context of some types of delusional beliefs, especially those involving the catastrophic and atypical misinterpretation of the physiological sensations associated with anxiety. This case emphasises the therapeutic value for certain patients of focussing therapy on the non-psychotic symptoms once the acute psychotic state has been managed.

Group psychotherapy for parents of patients with schizophrenia.

BACKGROUND: During a four-month period, the authors provided group psychotherapy combining psychodynamic, supportive and psycho-educational approaches. The aim was to investigate whether this approach would enable parents of patients with schizophrenia to re-establish their psychic balance and the balance of the whole family system by reducing high expressed emotion. METHODS: The following tools were administered: a socio-cultural questionnaire, MMPI and PIE psychological tests and two questionnaires for group evaluation. RESULTS: The socio-cultural questionnaire showed that the group of parents is heterogeneous. MMPI profiles showed truthful answers and well organized thinking; there were no psychopathological symptoms. The PIE test showed increased dimensions of sociability and trust. The dimensions of fear, sorrow and anger were decreased. Combinations of primary emotions (marked sociability and high self-protection) show that the parents are cautious, responsible and tend to feel guilt. The parents evaluated the group work as interesting and helpful and the group as a place where the parents can overcome the stigma of the disease that affects them, get information, find help and friends and find a way out of their social isolation. CONCLUSION: This combined approach changes the emotional profile of parents, reduces high expressed emotions (fear, sorrow and anger) in parents and helps re-establish their psychic balance and the balance of the whole family system.