Mental health services in Croatia.

The Republic of Croatia is in central Europe, on the Mediterranean. A large majority of its 4 440 000 inhabitants are Croats (89.6%). The main religion is Roman Catholicism (88%). Sixteen per cent of the population is aged over 65 years. Croatia was a part of Yugoslavia after the Second World War until 1991, when Croatia declared independence. Following the declaration, Croatia was attacked by the Yugoslav army and by Serbia and suffered a devastating war (1991-95). The transition had consequences for mental health, for example a dramatic rise in the prevalence of post-traumatic stress disorder, especially among soldiers. The majority of soldiers received appropriate psychiatric treatment; there has, however, been an increase in claims motivated by secondary gain, as a result of government policy.

[Social functioning of schizophrenia patients without working capability]. / Socijalno funkcioniranje osoba oboljelih od shizofrenije lisenih poslovne sposobnosti.

The social functioning is an important criteria for evaluation when the decision about guardianship has to be made. Therefore, we investigated the differences in social functioning of persons under guardianship in comparison with persons without guardianship. Examinees (N=123) with diagnosed schizophrenia, accommodated at a social care institution for mentally ill persons, participated in the study. Adaptive function scale has been used for the evaluation of social functioning. The results were processed by statistic methods using SPSS and following methods have been used for statistics: descriptive analysis, regression analysis and group centroids. The results didn't show the statistically significant differences in social functioning between two groups of examinees. Also, there was no statistical significant difference in relation to the duration of illness, age and education. The results indicate the necessarily of taking into consideration the some other dimensions important for evaluation of mental capacity, especially when the decision about guardianship has to be made.

Lack of genetic association between the phospholipase A2 gene and bipolar mood disorder in a European multicentre case-control study.

The possible association between phospholipase A2 gene and bipolar mood disorder was examined in 557 bipolar patients and 725 controls (all personally interviewed), recruited from seven countries (Belgium, Bulgaria, Croatia, Germany, Greece, Italy, and UK). The frequencies of the eight alleles that were identified did not differ between patients and control individuals in the whole population, while the power to detect an association based on our sample was relatively high. Some differences were noted among the various ethnic groups, but no significant trends existed, suggesting that population stratification by country may not be responsible for a type II error. On the basis of these results, mutations of the phospholipase A2 gene, at least in the region close to the polymorphism examined between exons 1 and 2, are not involved in the pathogenesis of bipolar mood disorder.

Importance of object relations theories for development of capacity for mature love.

We discuss Klein's, Winnicott's, and Mahler's object relational theories relevant for creating and maintaining the mature love relationship. The concept of love refers to the basic human relationship. The capacity for adult love involves the attainment of the relation towards the object as whole, satisfying the emotional needs of the self, including simultaneous tolerance of the specific needs of the object. It also involves the optimum resolution of anxiety related to schizo-paranoid and depressive positions and phases of separation and individuation. Primitive defense mechanisms, such as splitting, are replaced by more mature defense mechanisms, and primitive idealization is replaced by more mature idealization. The fusion with the object is reversible and helps in creating the experience of closeness with the partner, while the possibility of separation provides the possibility of recognizing and respecting the differences. Obstacles in the development of object relationships from pre-object to object phase, from symbiotic to separation and individuation phase can impair the capacity to love.

Posttraumatic stress disorder among women after the war in Sarajevo: a rationale for genetic study.

An exposure to extreme trauma events leads to posttraumatic stress disorder (PTSD) in up to 14-50% of war survivors. Recent findings suggest that genetic factors could play a certain role in PTSD development. In order to illustrate this possibility, we present results of a pilot study on gender specific sample of Sarajevo civilians immediately after the war cessation. During the period 1992-1995, Sarajevo civilians experienced continuous life threatening events with a great risk of developing PTSD in such conditions. Our study included 100 women adjusted to same socio-demographic characteristics. All women were interviewed using Harvard Trauma Questionnaire (HTQ) and divided into two groups (domestic and returnees) according to exposure length to extreme war life events of six or forty-three months. Above 50% of total analysed sample fulfilled criteria for PTSD. Regarding duration in trauma exposure no significant difference between these two groups were found. The only significant predictor found was physical abuse (p>0.01) that still cannot explain why some women develop PTSD while others not. Several years after the war, PTSD frequencies are decreased and disorder became chronic and more severe. However, the PTSD prevalence remains high when compared to general population rates. Therefore, Sarajevo population being exposed for almost four years to extreme war life events represents unique model for comparative research on PTSD etiology within the light of latest findings in molecular genetics of PTSD.

Genetic association between the phospholipase A2 gene and unipolar affective disorder: a multicentre case-control study.

The co-segregation in one pedigree of bipolar affective disorder with Darier's disease whose gene is on chromosome 12q23-q24.1, and findings from linkage and association studies with the neighbouring gene of phospholipase A2 (PLA2) indicate that PLA2 may be considered as a candidate gene for affective disorders. All relevant genetic association studies, however, were conducted on bipolar patients. In the present study, the possible association between the PLA2 gene and unipolar affective disorder was examined on 321 unipolar patients and 604 controls (all personally interviewed), recruited from six countries (Belgium, Bulgaria, Croatia, Germany, Greece, and Italy) participating in the European Collaborative Project on Affective Disorders. After controlling for population group and gender, one of the eight alleles of the investigated marker (allele 7) was found to be more frequent among unipolar patients with more than three major depressive episodes than among controls (P<0.01); genotypic association was also observed, under the dominant model of genetic transmission (P<0.02). In addition, presence of allele 7 was correlated with a higher frequency of depressive episodes (P<0.02). These findings suggest that structural variations at the PLA2 gene or the chromosomal region around it may confer susceptibility for unipolar affective disorder.

Types of transference studied in group of schizophrenic patients.

In order to find out what within the patient-therapist relationship can influence outcome, transference- countratransference patterns have been studied in the framework of psychodynamic treatment setting. The sample consisted of 40 female schizophrenic patients. All patients were interviewed by SADS-L, and diagnosed according to DSM III R rules including the course of illness. Level of social functioning was assessed on SADS-L scale. The transference/countratransference pattern was assessed by independent observer on the basis of especially designed questionnaire in active phase of illness and in the remission phase. The study found out that some transference patterns are associated with certain phase of illness, course of illness and level of social functioning. Neurotic transference pattern was associated with course of illness-remission. We do not know to which extent it is, or is it at all, related with schizophrenic's premorbid functioning or to the schizophrenic disease itself.

Positive association of dopamine D2 receptor polymorphism with bipolar affective disorder in a European Multicenter Association Study of affective disorders.

Convincing evidence for a genetic component in the etiology of affective disorders (AD), including bipolar affective disorder (BPAD) and unipolar affective disorder (UPAD), is supported by traditional and molecular genetic studies. Most arguments lead to the complex inheritance hypothesis, suggesting that the mode of inheritance is probably not Mendelian but most likely oligogenic (or polygenic) and that the contribution of genes could be moderate or weak. The purpose of the present European multicenter study (13 centers) was to test the potential role in BPAD and UPAD of two candidate dopaminergic markers, DRD2 and DRD3, using a case-control association design. The following samples were analyzed for DRD2: 358 BPAD/358 control (C) and 133 UPAD/ 133 C subjects, and for DRD3: 325 BPAD/ 325 C and 136 UPAD/136 C subjects. Patients and controls were individually matched for sex, age ( plus minus five years) and geographical origin. Evidence for significant association between BPAD and DRD2 emerged, with an over-representation of genotype 5-5 (P=0.004) and allele 5 (P=0.002) in BPAD cases compared to controls. No association was found for DRD2 in UPAD, and for DRD3 neither in BPAD or UPAD. Our results suggest that the DRD2 microsatellite may be in linkage disequilibrium with a nearby genetic variant involved in the susceptibility to BPAD. Our large European sample allowed for replicating of some previous reported positive findings obtained in other study populations.