FACTORS ASSOCIATED WITH DEPRESSION IN PATIENTS WITH SCHIZOPHRENIA.

The aim of this study was to analyze risk factors present in schizophrenic patients with depressive symptomatology. The sample comprised of 76 respondents diagnosed with schizophrenia. In the study, we used the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia. The prevalence of depression was estimated to be 30%. The mean scores on the negative subscale of the PANSS were significantly higher in patients with schizophrenia and depression compared to control group (U=3.64, p=0.00), and so were those on the General Psychopathology Scale (U=4.91, p=0.00). Socio-demographic factors were identified as important factors (p<0.05). Personal and environmental factors such as loneliness, immediate social environment, social support and isolation were statistically significantly different between the groups (p<0.05). There was a correlation of poor compliance with psycho-pharmacotherapy, increased number of hospitalizations and shorter remission period with the severity of clinical presentation (p<0.05). Since the presence of these factors is associated with depression in schizophrenia, their early detection in clinical practice is vital to ensure timely prevention of the development of depressive symptomatology.

Prevalence and Correlates of Aggression and Hostility in Hospitalized Schizophrenic Patients.

This study is aimed at identifying the incidence as well as clinical and socio-demographic correlates of aggression in hospitalized schizophrenic patients. We prospectively recruited participants with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnosis of schizophrenia presenting to the Clinic for Psychiatry during a 2-year period. We used the Modified Overt Aggression Scale to assess the aggression and Positive and Negative Syndrome Scale (PANSS) to assess the clinical characteristics of participants. One out of three patients with schizophrenia (31%) was aggressive and hostile at the time of presentation. Socio-demographic variables (such as gender, age, duration of illness, and number of hospitalizations) were poor predictors of aggression for schizophrenic patients. The level of aggression was not associated with the clinical characteristics in aggressive and hostile hospitalized schizophrenic patients. However, there was a weak negative association between the level of aggression and the PANSS Negative Scale ( p < .01). In conclusion, socio-demographic variables and clinical characteristics seem to be not such good predictors of aggressive behavior in hospitalized schizophrenic patients. Nevertheless, the results of our study contribute to the understanding of the prediction and treatment of aggression in a well-defined cohort of schizophrenic patients.

SOCIODEMOGRAPHIC AND PSYCHIATRIC CHARACTERISTICS AMONG HOMICIDE OFFENDERS IN SERBIA - THE PROVINCE OF VOJVODINA (1996-2005).

INTRODUCTION: Recent studies have shown a growing correlation between violence and mental illness, but there is a higher risk of violent crimes only in certain cases of mental disorders. This study presents sociodemographic and psychiatric characteristics of homicide offenders in Serbia, in the Province of Vojvodina in a 10-year period (1996-2005). Material and Methods~ The obtained data are based on performed forensic and psychiatric expert investigatfons of 154 homicide offenders in preceding period, considering sociodemographic data, personal history and current psychiatric status. Data were analyzed using the statistical John's Macintosh programe. RESULTS: The male offenders were in the great majority (92%) as well as a low level of education (87%). A positive history of criminal acts was found in 24% of the subjects. Minority of subjects (21%) consumed alcohol on a daily basis. At the time of committing the crimes, 57% of homicide offenders were under the influence of alcohol, and just 2% of other psychoactive substances. Among the offenders who had previously received psychiatric treatment (31.2%), the most frequent diagnosis was alcohol addiction (25%) and anxiety disorders (22.9%). During the psychiatric examination 70.8% of the subjects were diagnosed with mental disorder: personality disorders (41%), alcohol addiction (84%), neurotic disorders (65%), schizophrenic psychosis (5.2%), affective disorders (3.2%), paranoid psychosis (2.6%), organic disorders (19%), psychoactive drug addiction (13%) and mental retardation (0.6%). Emotionally unstable personality disorder was dominant among personality disorders (55.6%). Diminished mental competency was established in 77.9% of subjects at the time of the homicide, being rather sever in most of them. All those diagnosed to have a psychotic disorder were mentally incompetent. CONCLUSION: Emotionally unstable disorders were the most common among the offenders who underwent forensic evaluation. A relatively low presence of psychotic disorders imposes the need for de-stigmatization particularly of the patients suffering from major mental illnesses.

Professional stress and health among critical care nurses in Serbia.

The aim of this study was to identify and analyse professional stressors, evaluate the level of stress in nurses in Intensive Care Units (ICU), and assess the correlation between the perception of stress and psychological and somatic symptoms or diseases shown by nurses. The research, designed as a cross-sectional study, was carried out in the Intensive Care Units (ICU), in health centres in Serbia. The sample population encompassed 1000 nurses. Expanded Nursing Stress Scale (ENSS) was used as the research instrument. ENSS revealed a valid metric characteristic within our sample population. Nurses from ICUs rated situations involving physical and psychological working environments as the most stressful ones, whereas situations related to social working environment were described as less stressful; however, the differences in the perception of stressfulness of these environments were minor. Socio-demographic determinants of the participants (age, marital status and education level) significantly affected the perception of stress at work. Significant differences in the perception of stressfulness of particular stress factors were observed among nurses with respect to psychological and somatic symptoms (such as headache, insomnia, fatigue, despair, lower back pain, mood swings etc.) and certain diseases (such as hypertension, myocardial infarction, stroke, diabetes mellitus etc). In view of permanent escalation of professional stressors, creating a supportive working environment is essential for positive health outcomes, prevention of job-related diseases and better protection of already ill nurses.

Effects of exercise on physical fitness in children with intellectual disability.

This paper presents the results of the study which examined the effects of carefully designed physical exercise programs on the development of physical fitness in children with ID. The study sample consisted of 42 children with ID and 45 typically developing children. All the participants were assessed using Eurofit Test Battery. The results were analyzed in terms of participation in the exercise program and level of intellectual functioning. While ID children scored significantly lower on fitness tests when compared with typically developing children, the study revealed an association between degree of ID and physical fitness.

[Mother's filicide with suicide attempt].

INTRODUCTION: Filicide is the killing of a son or daughter by a parent. The paper examines interaction between stress and maternal psychopathology that led to the killing. CASE OUTLINE: After prolonged conflict with her ex-husband and father of her only child, the respondent committed filicide. Two years before committing filicide, after she had divorced the father of the child, the respondent attempted suicide and had to be hospitalized. On that occasion, she was diagnosed with depressive disorder, which was not treated after hospitalization. Having killed her daughter by cutting her throat, she tried to commit suicide in the same manner, by slitting her throat. During further observation, the respondent was found to suffer from acute psychotic disorder, depressive disorder and histrionic personality disorder. These disorders in interaction with stress do not provide us with an explanation for an unusual and psychopathological motivation analysis of killing the child. CONCLUSION: Filicide is a violent act, most frequently multifactorial in its nature. Histrionic personality disorder in mother cannot explain the filicide act. Only interactive and dynamic evaluation of this psychiatric disorder in its longitudinal, development aspects and its potentiality to enable the expression of some other psychiatric disorders, especially dissociative states, as well as the importance of prolonged and acute stress and its subjective importance for the individual can shed some more light on the mental state of the mother at the time of filicide.

Evaluation of quality of life for patients with schizophrenic and schizoaffective disorders related to the use of antipsychotic therapy.

The purpose of the study was to understand the impact of using antipsychotics in the treatment of schizophrenic and schizoaffective disorders related to the quality of life and overall social functioning of schizophrenic patients. In addition to this, the study monitored and compared the efficacy of classical, commonly used antipsychotics to that of atypical antipsychotic drugs with respect to the velocity and degree of reduction in symptoms of the primary disease. The 160 respondents who participated in this research were divided into two groups of 80. The respondents in the first group (A) were treated with atypical antipsychotics, whereas the respondents in the second group were treated with classical antipsychotics. The respondents were observed over a one-year monitoring period. Therapeutic effect of the used medicamentous therapy was monitored by means of a PANSS and CGI scales, while the velocity and degree of reduction in social functioning was monitored using the Quality of Life scale (QLS) - Heinrich-Hanlon-Carpenter-scale. The results show a remarkably improved social rehabilitation and a better quality of life, as well as higher reduction in symptoms among the respondents treated with atypical antipsychotics compared to the ones treated with classical antipsychotics.

Psychological assessment of persons following suicide attempt by self-poisoning.

BACKGROUND/AIM: Urgent psychiatric help and effective psychotherapeutic treatments are required soon after revival of a person after suicide attempt by self-poisoning. The aim of this article was to define an assessment of actual psychological characteristics of a person after suicide attempt by self-poisoning in order to apply psychotherapeutic crisis intervention after suicide attempt, as well as to show an approach to the treatment guided by the assessment that uses a psychodynamic model of suicidal crisis intervention based on our clinical experience. METHODS: Hamilton Depression Rating Scale (HAMD), Center for Epidemiological Studies-Depression Scale (CES-D), Defensive Questionnaire Scale (DSQ-40), Scaling of Life Events (Paykel), and Pierce Suicide Intent Scale (SIS) were applied in 30 hospitalized persons following suicide attempt by self-poisoning and in 30 patients who had asked for psychiatric examination at the outpatient clinic due to various life crises not resulting in suicide attempt. The examinees of both groups were matched by sex, age, and education, professional and marital status. Comparison of the patient groups was done by the t-test. Logistic regression analysis was used for suicidal risk assessment. RESULTS: The suicide attempters were depressed (HAMD = 22.60 +/- 5.93, CES-D = 29.67 +/- 7.99), with medium suicide risk factor (SIS = 4.5 +/- 4.17), using immature (projection, dissociation, devaluation, acting-out) and neurotic (altruism) defense mechanisms. The most important motives for suicide attempt were separation problems, problems with parents and a problem of loneliness. The commonest feelings and thoughts of a subject preceding suicide attempt were a wish to escape an unbearable situation, loss of control, desire to show love for a partner and wish to be helped. After a suicide attempt, 90% of the persons felt relief because the attempt failed, although almost half of them intend to repeat it. The risk of repeated suicide attempt was 1.8 (90% CI = 0.09-37.70, p < 0.001) times higher if values on the SIS Total Score were increased and 1.62 (90% CI = 0.03-81.39, p < 0.001) times higher if values on the SIS 1 (Circumstances Score) subscale were increased, too. CONCLUSION: Before starting with psychotherapy for persons after suicide attempt by self-poisoning it is very important to define psychological assessment of a person, choose the treatment (out-patient clinic or inpatient/hospital), assess indications for pharmacotherapy and psychotherapy that also must include a selection of patients for application of this therapeutic method. Assessment of conscientious and unconscientious conflicts leading to a suicide attempt represents initial basis for a therapist's work with a patient after suicide attempt and for application of psychotherapeutic crisis intervention.