Efficasy of Different Psychiatric Treatment Methods of Liaison Psychiatrist in Treatment of Women with Breast Cancer.

Being diagnosed with breast cancer is a traumatic event that can lead to development of different mental disorders and influences all aspects of affected woman's life. Anxiety and Depressive Disorders in physically ill people still don't have clear diagnostic criteria which make diagnosis and treatment very difficult since different psychiatric therapeutic approaches have different effects. The aim was to evaluate influence of separate and combined psychotherapeutic approach (psychodynamic and cognitive-behavioral) and psychopharmacotherapy on decrease of anxiety and depression in breast cancer patients. The sample consisted of 120 subjects divided into four groups. The first group of patients was treated with psychopharmacotherapy, the second group received psychotherapy, the third group was treated with the combination of psychopharmacotherapy and psychotherapy, and the fourth group of patients didn't receive any kind of psychiatric treatment. We used psychotherapeutic interview with detailed clinical assessment using DSM-IV criteria for mental disorders, specially structured non-standardized questionnaire for assessment of etiological factors in development of mental disorders, Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D). The subjects filled the questionnaires on entry, one moth and two months after the beginning of research. Psychotherapeutic treatment was conducted once a week. All of the therapeutic approaches of liaison psychiatrist applied in the treatment of women with breast cancer are successful in reduction of anxiety and depression. Liaison psychiatrist's combined approach of psychopharmacological and psychotherapeutic treatment of breast cancer patients with depression obtained better results than separate approach.

Serum testosterone concentration in combat-related chronic posttraumatic stress disorder.

AIM: The primary aim of this study was to assess the testosterone levels of soldiers with posttraumatic stress disorder (PTSD), without considering their comorbid conditions, compared with the ones in the control group with combat experience. The secondary aim was to determine whether there was a difference in testosterone levels when the same group of soldiers with PTSD was divided according to their comorbid conditions into those with major depressive disorder (MDD) or alcohol dependence (ETOH) compared to the soldiers with PTSD with no comorbid conditions and the controls. METHODS: We analyzed serum testosterone in soldiers with PTSD without the division according to comorbid conditions (n = 66) in comparison to the controls (n = 34). We also analyzed testosterone in pure PTSD (n = 17), PTSD comorbid with MDD (n = 18), PTSD comorbid with ETOH (n = 31), and in the controls. RESULTS: Soldiers with PTSD, without considering comorbid conditions, did not show any difference in testosterone levels in comparison to the controls. However, when we divided the same PTSD sample based on comorbid conditions, pure PTSD showed significantly higher serum testosterone levels in comparison to PTSD comorbid with MDD, comorbid with ETOH, or controls. Also, there was no difference in testosterone levels between the PTSD groups with comorbid MDD, with comorbid ETOH, and the controls. CONCLUSIONS: We did not find any differences in testosterone levels between the soldiers with PTSD without considering comorbid conditions and the controls. Considering comorbid conditions, soldiers with PTSD without comorbid conditions had higher testosterone levels compared to soldiers with PTSD with comorbid MDD or ETOH, or the controls.

Influence of psychical trauma through transgenerational transfer on the development of traumatic reactions in women with diagnosed breast cancer.

Earlier experience of psychological trauma of a close person can through a transgenerational transfer influence traumatic reactions of a person going through a trauma at present, resulting in a repetition of earlier traumatic experiences and a development of a variety of mental disturbances. Purpose of our study was to evaluate the influence of transgenerational transfer on the development of Posttraumatic stress disorder (PTSD) in women with diagnosed breast cancer that had a family member with diagnosed cancer. The sample mainly consisted of 120 women treated in a Department of Oncology, Osijek University Hospital Center with diagnosis of newly discovered breast cancer, during the conduction of radio therapy having values Hamilton depression scale (HAM-D) from > or = 8 to < or = 24 or values Hamilton anxiety scale (HAM-A) from > or = 17 to < or = 30. Psychotherapeutic interview with a detailed clinical overview and with applying diagnostic criteria according to DSM-IV for mental disorders, specially structured non-standardized questionnaire for etiologic factors evaluation of the beginning of examinees' mental disorder, Los Angeles Symptom Checklist of PTSD symptoms (LASC), Hamilton's scale for anxiety evaluation (HAM-A) and Hamilton's scale for depression evaluation (HAM-D) were used. Results show that 61 (51%) of patients have a family member with diagnosed cancer. The average total value on LASC for examinees that had a family member with diagnosed cancer was slightly higher (22.92) in comparison to those who had no such family member (20.88). No statistically significant connection was found between having a family member with diagnosed cancer and the average total value on LASC. Although no connection was established between having a family member with diagnosed cancer and the average value on LASC in women with diagnosed breast cancer, transgenerational transfer of emotions seems to be important in their traumatic reactions, but it is still insufficiently researched and it is a challenge for future researches leaving many complicated issues open.

Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls.

Intrathyroidal parathyroid carcinoma is extremely rare clinical entity with potentially multiple diagnostic pitfalls. We report a case of 40-year-old man presented with classical manifestations of primary hyperparathyroidism, severe hypercalcemia and profoundly increased serum parathyroid hormone level. Neck ultrasonography demonstrated multinodular goiter with predominant 34 mm nodule in left thyroid lobe. Additional 16 mm nodule was found beneath the left lobe. Routine percutaneous fine-needle aspiration of predominant nodule indicated follicular thyroid carcinoma, while left inferior nodule was confirmed to be of parathyroid origin. The patient underwent surgery, during which frozen sections identified medullary thyroid carcinoma with metastasis to upper mediastinal lymph node. Permanent sections of the predominant left lobe nodule revealed intrathyroidal parathyroid carcinoma surrounded with multiple microscopic metastases. Left inferior nodule was metastatic lymph node. Additional 10 mm intrathyroidal metastasis of primary parathyroid carcinoma was found within right thyroid lobe. This case indicates that fine-needle-aspiration and intraoperative biopsy are of limited value in diagnosing parathyroid carcinoma, especially if localized intrathyroidally. Oncological en-block resection is treatment of choice, implying ipsilateral lobectomy in case of thyroid invasion. This firstly described case of intrathyroidal parathyroid carcinoma causing intrathyroidal dissemination may influence future treatment strategies.

Epidemiological study of suicide in Croatia (1993-2003)--comparison of Mediterranean and continental areas.

The aim of this study is to analyze eventual differences in characteristic of suicide between two areas of the Republic of Croatia, mediterranean and continental, according to the following variables: suicidal rates, season, month, day, method, places, socioeconomic variables such as gender, ages, marital status, employment, education, and psychiatric or medical characteristic. Data were collected from the Suicide register of the Ministry of Interior, and Croatian Bureau of Statistic. Analysis was done on all suicide cases committed in the period 1993-2003. According to the Suicide Register of Ministry of Interior, 11,359 suicides were reported in period between 1993 and 2003. The average suicide rate in the Mediterranean area was lower (16.44 suicides per year) than in continental area of Croatia (26.34 suicides per year). Suicide committers in the Mediterranean area was statistically significant younger than suicide committers in the continental area of Croatia. In the continental area male suicide committers were more often than in the Mediterranean area of Croatia. In the Mediterranean area suicide committers were in most cases with high school education while in continental area of Croatia most cases of suicide committers were with elementary school education. Alcohol dependence, family conflicts, and medical disorders were more often present as suicidal motive in suicide committers in continental area of Croatia than in the Mediterranean area where undefined and unknown reason of suicide is present in majority of suicide cases. Cold steel, drowning, and jumping from height were more often present as suicidal method in the Mediterranean area of Croatia opposite to continental area of Croatia where jumping in front of car or train and suicide with firearms and explosive were more often. Also, in the Mediterranean area of Croatia suicides was mostly committed on open spaces and public places while in continental area of Croatia suicides was mostly committed in private plot.

Factores biológicos en pacientes con Trastorno de Estrés Postraumático (PTSD) y Alcoholismo

Los acontecimientos traumáticos que sobrepasan la experiencia humana normal, tales como las situaciones que ponen en peligro la vida o la integridad física o la exposición de personas próximas a un peligro similar, pueden producir determinados problemas psicológicos en el individuo, que se describen en el marco de un trastorno denominado Trastorno de Estrés Postraumático. La exposición a numerosos acontecimientos e influencias estresantes produce, como resultado de numerosos factores, el que el organismo desencadene una serie de mecanismos de defensa, en los que juega un papel fundamental el Sistema Nervioso Central, pero también el sistema suprarrenal y el cardiorespiratorio. Cuando la homeostasis interna está en peligro, se activa el sistema endocrino y su respuesta al peligro depende de la intensidad del agente causante del estrés, de la duración de la exposición y de la capacidad del sistema para compensar el estrés. La exposición al estrés y el efecto directo del agente causante de estrés desencadena además otro mecanismo de defensa, cual es el aumento del consumo de alcohol a modo de automedicación y bajo la influencia directa del agente causante de estrés. Tanto el PTSD como el alcoholismo conducen de forma gradual a la afectación del sistema neuroendocrino. En nuestro estudio hemos incluido dos grupos de pacientes, concretamente el grupo de pacientes que padecen de PTSD y de alcoholismo y el grupo de pacientes que padecen únicamente de PTSD. Hemos llevado a cabo la evaluación de los niveles de cortisol en suero y en la orina de 24 horas, el test de supresión de la dexametasona y los niveles en suero de ACTH, TSH, T3, T4, testosterona, prolactina y hormona del crecimiento. Los resultados obtenidos llevan a considerar la presencia de alteraciones en los ejes neuroendocrinos en los dos grupos de esta investigación, alteraciones que se presentan más marcadas en el grupo de sujetos que presentan comorbilidad de PTSD y alcoholismo (AU)