[Epidemiological study of psychiatric hospitalizations in general hospital Bjelovar]. / Epidemioloska slika psihijatrijskih hospitalizacija u opcoj bolnici Bjelovar.

Summary. Based on the data provided by the Registry of the Department of Psychiatry, General Hospital Bjelovar, an epidemiological study of the hospital treated patients for the years 1980, 1985, 1990, 1995, 2000, 2005 and 2010 was made. In determining the diagnostic groups, the authors used the International Classification of Diseases ICD-10 and the World Health Organization's (WHO) recommendations, adjusting all diagnostic entities to that classification. The study sample consists of patients hospitalized at the Department of Psychiatry, General Hospital Bjelovar in the years mentioned above. Following parameters were analyzed: total number of hospitalizations, gender, age and hospitalization outcome--by diagnostic groups. What is noted is the decrease in the total number of psychiatric hospitalizations, the reduction of the proportion of men and women in the sample, and the decrease of mortality. In the observed period, the number of hospitalized patients diagnosed as alcoholics decreased, and the number of patients hospitalized with diagnosed as alcoholics decreased, and the number of patients hospitalized with diagnosed dementia, affective disorders, and critical conditions increased, while the number of the hospitalized schizophrenic patients has been oscillating. The main differences between the results of the initial and final year of the epidemiological study have been analyzed by the chi square test. The results of the epidemiological study shall help the evaluation, rational planning and further development in the protection of mental health of the inhabitants of the Bjelovar-Bilogora County.

[Suicides in Bjelovar-Bilogora County in the war period, pre-war and post-war period, and the period of the economic expansion and recession]. / Samoubojstva na Podrucju bjelovarsko-Bilogorske Zupanije u prijeratnom, ratnom i poratnom razdoblju te razdoblju ekspanzije i recesije.

In the sample of 1134 suicides committed in the period 1988-2011 in Bjelovar-Bilogora County, we have analyzed the number of suicides, methods, scene and time of committing, gender, age and probable motives, comparing results from the Homeland war period, pre-war and post-war period, and the period of the economic expansion and recession. The study results show increase in the suicide rate in wartime and stagnation in the period of the recession. Age-standardized suicide rates for all ages are higher than the Croatian average. Men commit suicides more than women, and 3.53% of the total number of suicides are committed by minors. The most frequent method of performing suicide was by hanging, most suicides were committed in the morning hours, in the spring months, in closed buildings (houses, outbuildings), the most probable motive for suicide is a disease. Seen by periods, suicide rate is the highest in the wartime, with an increase in the percentage of suicides committed by firearms and explosives, and outdoor committed suicides. During the period of the expansion and the recession, we note a shift of suicides toward people in their fifties. The ratio of male and female suicides is the highest in the periods of crisis.

Impact of posttraumatic stress disorder on sinonasal symptoms and quality of life in patients with chronic rhinosinusitis.

BACKGROUND: Severity of chronic rhinosinusitis (CRS), measured by disease-specific health-related quality-of-life questionnaires, is expected to increase in patients who also suffer from posttraumatic stress disorder (PTSD). Altered pain perception, sleep disorders, and fatigue may be associated with this comorbidity. METHODS: Severity of CRS was compared between a group of 28 patients with CRS and a group of 28 patients with CRS and concomitant PTSD using different disease-specific and generic instruments, such as visual analog scale (VAS), Short Form-36 test (SF-36), and Sino-Nasal Outcome Test-22 (SNOT 22). RESULTS: SNOT-22 test showed significantly higher CRS severity in patients with CRS and PTSD, compared to patients with CRS without PTSD. CONCLUSION: Patients with less severe CRS, measured by objective outcome measures, due to the impact of comorbid PTSP, are classified as having severe rhinosinusitis, and are exposed to the risk of unnecessary diagnostic and therapeutic procedures. In patients with difficult-to-treat rhinosinusitis, diagnosis should be revised, and one item that should be evaluated is whether they suffer from PTSD.

Hopelessness, suicidality and religious coping in Croatian war veterans with PTSD.

BACKGROUND: Hopelessness is a strong predictor of suicide which is closely associated with PTSD in war veterans. Previous studies showed that if religious faith in war veterans was weakened it contributed to more extensive current use of mental health services. War trauma experience can weaken religious faith as well as strengthen it. It partly depends on religious coping which can be positive or negative. SUBJECTS AND METHODS: In our work we present correlation between hopelessness (measured with Beck Hopelessness Scale) and style of religious coping (positive or negative, measured with R-COPE) in 111 Croatian war veterans with PTSD and 39 healthy volunteers. RESULTS: Veterans with PTSD were more hopeless than healthy volunteers, and had greater usage of negative religious coping. In PTSD group, less hopeless veterans showed greater extent in use of positive religious coping strategies. CONCLUSION: These findings suggest that experts treating male combat veterans with PTSD should inquire about religious coping of the individual. Positive religious coping should be encouraged while negative religious coping should be addressed appropriately.

[Excessive daytime sleepiness--as possible suicidal equivalent in people with depressive disorder]. / Prekomjerna dnevna pospanost kao moguci suicidalni ekvivalent u osobe oboljele od depresivnog poremecaja.

This paper presents the case of a patient suffering from atypical depression, with excessive daytime sleepiness, which was a suicidal equivalent. Patients who suffer from depression and sleep disorders can have an increased risk of suicidality, and to them should pay increased attention. Field of suicide as a means of resolving conflicts and unconscious mental escape from the reality of the obstacles, including sleep and daytime sleepiness, which may represent a form of "temporary suicide". The authors recommend that hypersomnia, daytime sleepiness in depressed patients and other sleep disorders should be treated as a potential risk factor for suicidal behavior.

Spiritual well-being, cortisol, and suicidality in Croatian war veterans suffering from PTSD.

We present our preliminary results of work that aims to observe the relationship between the cortisol level, the level of spiritual well-being, and suicidal tendencies in Croatian war veterans suffering from PTSD. The survey was conducted on 17 PTSD veterans who completed the Spiritual Well-Being Scale and the Beck Hopelessness Scale. The plasma cortisol level was obtained by venepuction at 8.00, 12.00, 13.00, 16.00, and 22.00 h. Results showed that veterans with higher spiritual well-being scores had lower cortisol levels, and evening cortisol levels showed significant correlation with suicidal risk. The results of the present study could be a stimulus for further investigation into spiritually based interventions, exploring their impact both on mental status and physical health.

The impact of psoriasis on the quality of life and psychological characteristics of persons suffering from psoriasis.

Psoriasis, as same as other skin diseases, has an influence on many spheres of patient's life. It influences the mental image the patients have of themselves and it indirectly shapes their personality traits as well as it defines the quality of their lives. The purpose of the study was to examine the impact of psoriasis on the quality of life and gender differences in the quality of life and explore presence of neurotic symptoms among persons suffering from psoriasis in comparison to general population. During the treatment of persons suffering from psoriasis at the special hospital Naftalan in Ivanic Grad personality questionnaire and Quality of life scale were administered to 61 participants (m = 25; f = 36). Our results showed few gender differences in the satisfaction with specific life domains, but only differences in the satisfaction with sexual life could be related to the different effects psoriasis has on the quality of life of men and women. Our participants experience more anxiety and depression symptoms as well phobic fears in comparison to general population. Found genders differences in the presence and intensity of anxiety symptoms closely resemble those documented in the general population therefore aren't typical for people suffering from psoriasis.

Personal experiences of the psoriasis and its relation to the stressful life events.

Psoriasis is a disease with a profound impact on the psychological and social aspects of the patient, particularly because of its visibility. Quality of life is impaired and different mental health disorders like depression, anxiety, alcoholism, posttraumatic stress disorder (PTSD) are found among persons suffering from psoriasis. Studies have shown the influence of stressful life events on onset, exacerbation and relapse of psoriasis. Rare studies explored prevalence of psoriasis during war times and relations between psoriasis and war provoked PTSD. Psoriasis is a disease with multiple possible causes and additional caution is necessary among medical professional to recognize all contributing factors. This report describes a case of a person whose first episode of psoriasis appeared six months after engaging in combat activities. He is diagnosed with psoriasis vulgaris, psoriatic arthritis and permanent personality changes after the traumatic experiences caused by war participation. His occupational history is burdened with additional causational factors; work with heavy metals and metal dusts. Cumulative effects of different aetiological factors can contribute to psoriasis with intensive trauma induced stressors serving as a trigger. His medical history indicates cognitive difficulties typical for early dementia which makes this case even more interesting. Research results suggesting common aetiology of psoriasis, autoimmune diseases and neurodegenerative diseases, indicate a need, as in the case of our patient, for multidisciplinary approach to studying aetiology of psoriasis.

"Alea Iacta Est" (a case series report of problem and pathological gambling).

Gambling or gaming is a common term for a group of various games, activities and behavior that involve wagering money on an event with an uncertain outcome with the primary intent of winning additional money, i.e., a player risks and hopes to get back what he/she had gambled, or to win more. When the player is unable to resist impulses to gamble, and gambling behavior harmfully affects him or the others, then he/she is suffering from the so called "pathological gambling", which is one of six categories of the "Impulse control disorders" in the International Classification of Diseases. Since, at present, there is no standardized program and approach to the problem of gambling in Croatia, and having in mind the arising accessibility and popularity of the "games of chance", the authors are presenting seven cases of problem and pathological gambling and call for broad public discussion on the problem from medical-psychiatric and forensic-point of view. The first patient was treated on an outpatient basis with cognitive-behavioral and family therapy for problem gambling; for the second patient was treated for impulse control disorders; for the third patient gambling was a symptom of psychotic form of depressive disorder; the fourth had primary diagnosis of personality disorder; and the fifth patient was prosecuted for armed robbery and evaluated by a psychiatric expert. The sixth and the seventh patients were women suffering from primary bipolar affective and major depressive disorder, respectively. The authors conclude that, due to the size of the problem and its consequences, the prevention of pathological gambling is very important. The prevention can be carried out primarily through screening at the school level and primary health care services, whereas secondary screening may be conducted through the system of psychiatric care. It is recommended to invest into research, education of a wider population, and development of preventive programs.

Ethics of the early intervention in the treatment of schizophrenia.

When second generation antipsychotics were introduced in the mid 1990-s they offered the possibility of early psychopharmacological interventions in the treatment of schizophrenia. The idea applying antipsychotics in the prodromal phase of schizophrenia today is an realistic option. However ethical dilemmas about offering antipsychotics to the adolescents with at risk mental states, of whom only a few are real prodromes of schizophrenia remain for clinicians. In the literature about the ethics of the early interventions in psychiatry there are still many ethical questions which call for caution because of the low predictive value of at risk mental states, of which only 40% turn out to be a real prodrome of schizophrenia. These ethical questions can be addressed in three categories: - how to best identify who should receive early pharmacological intervention? - what this intervention should consist of? - how to evaluate treatment efficacy in the absence of illness base rates in the adolescents with a real prodrome of schizophrenia? Besides, arguing against the concept of early psychopharmacological interventions in the adolescent population are the fact of the unknown effect of antipsychotics on the developing brain as well as negative effects of stigma on those adolescents who receive them. The authors in the article analyse these ethical questions and take the side of those clinicians who think that caution and careful ethical judgment are needed before the prescribing of antipsychotics to adolescents with at risk mental states.

[The Club of Croatian War Veterans treated for PTSD as a form of psychosocial rehabilitation]. / Klub hrvatskih branitelja iz domovinskog rata lijecenih od PTSP-a kao oblik psihosocijalne rehabilitacije.

For the period after the war patients with complex disorders are specific. Their increased need for psychiatric protection stimulates people to organize additional, outpatient activities in the mental health area. The authors present their experiences of working in the Club of Croatian War veterans treated for PTSD (the PTSD Club) and the positive therapeutic effect of systematic work upon the principles of sociotherapeutic community, systematic family approach, and self-help. The PTSD club is one of possible problem solutions, and the right choice of how to organize and conduct preventive and rehabilitative programs for high-risk groups of patients.

Glossolalia.

In this article the authors present through theory and case reports on the phenomenon of glossolalia, the unusual vocal utterances that sound language-like. Sense, meaning and function of glossolalia are closely connected with social and cultural context, and therefore glossolalia is experienced as a normal and expected behavior in religious prayer groups, while in mental disorders it is considered a psychopathological symptom. Historic theological debates explain the pure spiritual etiology of glossolalia, while the current studies present the phenomenon of glossolalia as a result of learned behavior and training. Glossolalia occurs as an individual or a group phenomenon after which the speaker and the persons around him feel good, what is explained psychodynamically as a regression upon early developmental levels. In this temporary regression there is an explanation of positive, almost psychotherapeutic effect of glossolalia.

The influence of risperidone on cognitive functions in schizophrenia.

Introduction of the antipsychotics of the second generation (SGA) into the therapy of schizophrenia roused expectations that, finally, the cognitive dysfunction in schizophrenia could be eliminated by psychopharmacological therapy. The purpose of the study was to verify the effect of atypical antipsychotic risperidone on cognitive functions in schizophrenic patients. The study was carried out upon 48 male schizophrenic patients aged 21-47 years who were switched from the antipsychotics of the first generation (FGA) to the antipsychotic risperidone, due to intolerance, during the treatment. Intelligence, abstract and concrete thinking and mental speed, attention, and short-term non-verbal memory prior to the switch, one month after the switch, and three months after the switch to risperidone, were evaluated. One month after the switch the number of subjects with severe impairment of intellectual abilities decreased significantly from 62% to 15% and after three months the number was even lower-8%. The impairment of concrete and abstract thinking and mental speed also showed the same tendencies of decrease. The improvement of the cognitive functioning after the switch from the antipsychotics of the first generation to the antipsychotic risperidone is explained by removal of the antipsychotics of the first generation from the therapy and the consequential disinhibition of secondary cognitive impairments and by decreased average dose of anticholinergic and decreased number of patients who need anticholinergic therapy beside risperidone. The possibility of clear pro-cognitive effect of risperidone is suggested and its verification is proposed with strict control of other factors that improve cognitive functioning of schizophrenic patients during the treatment.

Social phobia.

Social anxiety disorder (social phobia) is an irrational fear of being observed and judged by other people in various social settings. The individual is afraid that he or she will act in a way that will be humiliating or embarrassing. It is often a chronic, disabling condition that is characterized by a phobic avoidance of most social situations. Social anxiety disorder is the most frequent anxiety disorder (10-15%) that occurs in two subtypes--generalized and specific. It is a disorder that occurs during the adolescence and reflects negatively to the quality of life of an individual. Neurobiological basis of this disorder has not been explored yet. The disorder is frequently burdened with comorbidity with other anxiety disorders, depression and substance-related disorders. Only cognitive-behavioral techniques are desirable in the psychotherapeutic treatment of the disorder and the best results are achieved in combination with pharmacotherapy. The medicaments of choice in the treatment of social anxiety disorder are selective serotonin reuptake inhibitors. Anxiolytics should be used only as a supplementary in the acute phase. Treatment of social anxiety disorder should last at least 3 months up to one year.

Forensic importance of jealousy.

The aim of the investigation is to define as clearly as possible specific forensic psychiatric characteristics of persons who committed homicide and or attempted due to jealousy (the nature and severity of psychopathology, the level of responsibility, danger for the community, intensity and nature of aggression, the victimologic dimension, the relation of alcohol and jealousy). A retrospective method based on forensic psychiatric expertises in the period 1975-1999 was used. They encompassed 200 examinees that committed murder or attempted it. The results show the connection of psychotic jealousy with the highest degree of danger in diagnostic categories of paranoid psychosis and paranoid schizophrenia. The time span from the first manifestations of jealousy until the actual commitment of a crime is the longest in personality disorders and the shortest in schizophrenia. Exogenous provoking situations were dominant for committing homicide due to jealousy in personality disorders. Acute alcohol intoxication has a specific significance in crime due to jealousy in the same diagnostic category. Clear criteria were designed for forensic psychiatric evaluation of murder and attempts of homicide caused by jealousy, which will be of help in everyday practice in the field forensic work and treatment.