Guidelines for Individual and Group Psychodynamic Psychotherapy for the Treatment of Persons Diagnosed with Psychosis and/or Schizophrenia.

The hereby presented guidelines for the use of psychodynamic psychotherapy are based on references and research in the field of individual and group therapy and they refer to psychotherapy for patients suffering from the first psychotic episode, schizophrenia, schizoaffective psychosis, bipolar disorder and paranoid psychosis. The aim was to provide an overview of present literature and to give recommendations based on current knowledge. Clinical experience and research of the outcomes of psychodynamic psychotherapy encourage positioning of such treatments among recommendations for treating various mental disorders, as well as in the field of psychotherapy of patients with psychotic disorders (PD).

A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe.

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies.

Effects of a Group Psychoeducation Program on Self-Stigma, Empowerment and Perceived Discrimination of Persons with Schizophrenia.

BACKGROUND: Self-stigma adversely affects recovery from schizophrenia. Analyses of self stigma reduction programs discovered that few studies have investigated the impact of education about the illness on self-stigma reduction. The objective of this study was to determine whether psychoeducation based on the principles of recovery and empowerment using therapeutic group factors assists in reduction of self-stigma, increased empowerment and reduced perception of discrimination in patients with schizophrenia. SUBJECTS AND METHODS: 40 patients participated in psychoeducation group program and were compared with a control group of 40 patients placed on the waiting list for the same program. A Solomon four group design was used to control the influence of the pretest. Rating scales were used to measure internalized stigma, empowerment and perception of discrimination. Two-way analysis of variance was used to determine the main effects and interaction between the treatment and pretest. Simple analysis of variance with repeated measures was used to additionally test effect of treatment onself-stigma, empowerment and perceived discrimination. RESULTS: The participants in the psychoeducation group had lower scores on internalized stigma (F(1,76)=8.18; p<0.01) than the patients treated as usual. Analysis also confirmed the same effect with comparing experimental group before and after psychoeducation (F(1,19)=5.52; p<0.05). All participants showed a positive trend for empowerment. Psychoeducation did not influence perception of discrimination. CONCLUSION: Group psychoeducation decreased the level of self stigma. This intervention can assist in recovery from schizophrenia.

[The organization of mental health care in community]. / Organizacija zastite mentalnog zdravlja u zajednici.

Integration of the psychiatry in primary care is beneficial for the early detection of mental disorder, better outcome of mental disorder and reduction of stigma. Psychiatry is a leading profession in organisation of mental health services. General practitioners (GPs) in Europe deal with mental disorders in their everyday practice, so the same is expected in Croatia. Graduate and postgraduate education of our GPs is insufficient for this new role. The paper compares actual situation in Croatia with forthcoming needs. The paper suggests that community psychiatry, anti-stigma program, continuing medical education of GPs and network of consultant psychiatrists give the best results in the early detection and treatment of mental disorder.

Case management - a pillar of community psychiatry.

This review is describing different models of case management, showing their similarities and differences with regards to the way they operate. Good relationship between patient and case manager, application of the biopsychosocial model, availability of psychosocial treatment methods and rehabilitation programs, and individual treatment plan are all important factors in case management's success. Large number of studies supports the application of case management in practice as effective treatment method in treating people with severe mental disorder, particularly those, who are less co-operative. Therefore, the implementation of case management into psychiatric practice should be supported.

[Atipical antipsychotics in relation with social functioning]. / Atipicni antipsihotici i socijalno funkcioniranje.

We studied influence of type of antipsychotics in relation with social functioning in sample of 123 patients diagnozed with schizophrenia accordingto lCD 10 criteria. On atypicals (olanzapin, risperidon, clozapin) were 39 patients, 26 female and 13 male. The social functioning scale according to Bellak et al was used for assessment of social functioning. Results of our study show that there is no difference in social functioning between patients on atypical in comapration with patients on typical antipsychotics. We observed a positive trend of better social functioning in group of patients who takes atypicals. Results also showed that women had better social functioning comparing to males Education and duration of illness were not in relation with social functioning.

[Evaluation of residency programs in psychiatry]. / Procjena programa specijalizacije iz psihijatrije.

The paper investigates the characteristics of psychiatric residency in Croatia. During 1998 psychiatric residents were sent an anonymous questionnaire with questions related to obligatory training program in psychiatry according to regulations, control system, personal satisfaction, quality, supervising system, mentor, lectures, scientific work and literature. Data were analyzed by percentage analyses and chi square method. The results show some difficulties in respecting the obligatory program during the residency, insufficient supervision of clinical work, irregular consultation with mentor and unspecified educational material. Residents propose better program transparency, possibility to choose between the institutions, standardization of the program, precise definition of the mentor and supervision. Implementation of more transparent methods in the quality control of the training in psychiatry, as well as the importance of harmonization of psychiatric training in Croatia within UEMS requirements is suggested.