The Influence of Sociodemographic Factors on the Level of Hope in Women with Breast Cancer.

Background: We aimed to determine the level of hope in breast cancer patients along with the influence of sociodemographic characteristics on the expressed level of hope. Methods: A descriptive cross-sectional study was conducted on the sample size of 72 female patients with breast cancer diagnosis. The study was conducted at the University Clinical Center of Kragujevac, Serbia from November 2020 until March 2022. Data were collected from the patients in a form of the Sociodemographic Variables Questionnaire (Q-SV). The Herth Hope Index (HHI) was used in assessing the level of hope. Results: The value of the total HHI score was ranging from 14 to 48, whereas the mean value of the HHI score was 40.00±5.92. The significantly higher level of hope was reported in female patients who: searched the Internet for gathering information on their disease (39.24±6.23; P=0.047), were religious (38.77±6.13; P=0.003), believed in God (38.45±5.51; P=0.004), had no formal medical education (38.44±5.75; P=0.036) and after therapy (38.76±6.49; P=0.022). Conclusion: Hope is an existential internal resource possibly affecting the manner in which female patients perceive their own health state and future as well. A better understanding of the meaning of hope during treatment can be of great value in supporting cancer patients.

Escaping the Long Shadow Cast by Agranulocytosis: Reflections on Clozapine Pharmacovigilance Focused on the United Kingdom.

PURPOSE/BACKGROUND: A recent article in this journal presented a US perspective regarding the modernization of clozapine prescription and proposed an escape from the long shadow cast by agranulocytosis. METHODS: Here, an international group of collaborators discusses a point of view complementary to the US view by focusing on worldwide outcomes of clozapine usage that may be uneven in terms of frequency of clozapine adverse drug reactions. FINDINGS/RESULTS: Studies from the Scandinavian national registries (Finland and Denmark) did not find increased mortality in clozapine patients or any clear evidence of the alleged toxicity of clozapine. Data on clozapine-associated fatal outcomes were obtained from 2 recently published pharmacovigilance studies and from the UK pharmacovigilance database. A pharmacovigilance study focused on physician reports to assess worldwide lethality of drugs from 2010 to 2019 found 968 clozapine-associated fatal outcomes in the United Kingdom. Moreover, the United Kingdom accounted for 55% (968 of 1761) of worldwide and 90% (968 of 1073) of European fatal clozapine-associated outcomes. In a pharmacovigilance study from the UK database (from 2008 to 2017), clozapine was associated with 383 fatal outcomes/year including all reports from physicians and nonphysicians. From 2018 to 2021, UK clozapine-associated fatal outcomes increased to 440/year. IMPLICATIONS/CONCLUSIONS: The interpretation of fatal outcomes in each country using pharmacovigilance databases is limited and only allows gross comparisons; even with those limitations, the UK data seem concerning. Pneumonia and myocarditis may be more important than agranulocytosis in explaining the uneven distribution of fatal outcomes in clozapine patients across countries.

Do people diagnosed with psychosis spectrum disorders share the same personality space as the general population? Big Five complemented by the proneness to psychotic-like experiences/behaviors.

OBJECTIVE: Disintegration is a recently proposed broad, trait-like reconceptualization of the proneness to psychotic-like experiences/behaviors. METHODS: We tested the assumption that the 6-factor model (Five-Factor traits plus Disintegration) was the most adequate one and that it was invariant across clinical and non-clinical populations. The clinical sample (n = 161) consisted of patients who had at least one psychotic episode, duration of illness less than 10 years, currently in remission. The general population (n = 409) was matched with the patient sample by age, gender, and education. NEO PI-R and DELTA were used to measure personality dimensions in both samples. Invariance of one to six-factor solutions was tested by Exploratory Structural Equation Modeling. RESULTS: We found that: (a) several criteria for deciding on the number of factors to retain converged to the conclusion that the assumed 6-factor model was the most adequate one, (b) the assumed factorial structure appeared to satisfy the criteria for the scalar invariance across the two samples, (c) all nine Disintegration subdimensions separated from the Big Five, forming the Disintegration factor, and (d) Disintegration was unrelated to Openness. CONCLUSION: The Big Five personality structure-complemented with disintegration-was invariant across individuals from the general population and patients with psychosis.

Risperidone Induced Hyperprolactinemia: From Basic to Clinical Studies.

Risperidone is one of the most commonly used antipsychotics (AP), due to its safety and efficacy in reducing psychotic symptoms. Despite the favorable side effect profile, the therapy is accompanied by side effects due to the non-selectivity of this medicine. This review will briefly highlight the most important basic and clinical findings in this area, consider the clinical effects of AP-induced hyperprolactinemia (HPL), and suggest different approaches to the treatment.The route of application of this drug primarily affects the daily variation and the total concentration of drug levels in the blood, which consequently affects the appearance of side effects, either worsening or even reducing them. Our attention has been drawn to HPL, a frequent but neglected adverse effect observed in cases treated with Risperidone and its secondary manifestations. An increase in prolactin levels above the reference values result in impairment of other somatic functions (lactation, irregular menses, fertility) as well as a significant reduction in quality of life. It has been frequently shown that the side effects of the Risperidone are the most common cause of non-compliance with therapy, resulting in worsening of psychiatric symptoms and hospitalization. However, the mechanism of Risperidone-induced HPL is complicated and still far from fully understood. Most of the preclinical and clinical studies described in this study show that hyperprolactinemia is one of the most common if not the leading side effect of Risperidone therefore to improve the quality of life of these patients, clinicians must recognize and treat HPL associated with the use of these drugs.

[Brain tumors in patients primarly treated psychiatrically].

INTRODUCTION: Psychiatric symptoms are not rare manifestations of brain tumors. Brain tumors presented by symptoms of raised intracranial pressure, focal neurological signs, or convulsions are usually first seen by the neurologist or less frequently by the neurosurgeon in routine diagnostic procedures. On the other hand, when psychiatric symptoms are the first manifestation in "neurologically silent" brain tumors, the patients are sent to the psychiatrist for the treatment of psychiatric symptoms and brain tumors are left misdiagnosed for a long period of time. CASE REPORT: We presented three patients with the diagnosed brain tumor where psychiatrist had been the first specialist to be consulted. In all three cases neurological examination was generally unremarkable with no focal signs or features of raised intracranial pressure. CT scan demonstrated right insular tumor in a female patient with obsessive-compulsive disorder (OCD); right parietal temporal tumor in a patient with delusions and depression and left frontal tumor in a patient with history of alcohol dependency. CONCLUSION: Psychiatric symptoms/disorders in patients with brain tumors are not specific enough and can have the same clinical presentation as the genuine psychiatric disorder. Therefore, we emphasize the consideration of neuroimaging in patients with abrupt beginning of psychiatric symptoms, in those with a change in mental status, or when headaches suddenly appear or in cases of treatment resistant psychiatric disorders regardless the lack of neurological symptoms.

Penile self-mutilation - two cases in one family.

Male genital self-mutilation is an infrequently reported event in the general medical literature. The majority of cases deal with a single episode of self-mutilation. These cases are usually focused on surgical repair. We present an extremely rare situation of two cases of male genital self-mutilation occurring in the same family. Both patients were treated for schizophrenia. Both patients had religious psychotic experiences and guilt feelings associated with sexual conflicts. Both patients had an experience of setting fire. Although they were close relatives, the younger did not imitate the older one when he mutilated his genitals. The possible causes of such behavior have been analyzed in the light of the recent literature.

[Factors which influence postoperative mortality after hip fracture].

BACKGROUND/AIM: One of the most significant predictors of mortality after hip fractures is cognitive impairment (dementia). The aim of this study was to report the results of a prospective study of the influence of some factors on six-month mortality in elderly patients with hip fractures. METHOD: The elderly patients with hip fracture were assessed on admission to the hospital using the measures of cognitive function, the mobility before the fracture, and physical comorbidity, the type of fracture and the place of the injury. Six months later, we checked how many of them were still alive. RESULTS: We performed univariate and multivariate analyses in 132 patients and found that the most significant predictors of six-month mortality were dementia, comorbidity, and prefacture mobility. CONCLUSIONS: A comprehensive physical and mental health assessment of an elderly patient after hip fracture could predict mortality. A good examination of cognitive functioning could be very useful in choosing the optimal treatment for this type of patients.