Changes in the Long-Term Psychodynamic Group Psychotherapy in Family Members of Persons with Psychotic Disorders.

BACKGROUND: The experience gained in working with psychotic persons as well as the findings from the literature have pointed to the need for systematic inclusion of the families of affected individuals, facilitating the creation of partnership within treatment, and to the need for a better understanding of family dynamics that reflects on the psychological conditions of the patients. AIM: The aim of this paper is to explore the changes in self-esteem and loneliness of group members during the therapeutic process and whether the use of more mature defence mechanisms is the answer to the treatment of group psychotherapy. SUBJECTS AND METHODS: We followed three groups of 30 members (18 women and 12 men). At the beginning of inclusion in group psychodynamic psychotherapy and after 18 months of psychotherapy, members completed the following questionnaires: Rosenberg Self-esteem Scale, short version of UCLA Loneliness Scale (ULS-7) and Lifestyle Questionnaire (LSI). RESULTS: The research results show a statistically significant increase in self-esteem, a significant reduction in loneliness, and significantly reduced use of defence mechanisms after 18 months of group psychotherapy. CONCLUSION: Research findings confirmed positive changes in family members who gradually feel better and safer, with less anxiety and fear, all positively reflecting on the family atmosphere, the ability to accept and understand the sick member, as well as his better quality of recovery.

Early intervention programme for patients with psychotic disorders in "Sveti Ivan" Psychiatric hospital (RIPEPP) - sociodemographic and baseline characteristics of the participants.

BACKGROUND: Psychiatric hospital "Sveti Ivan" in Zagreb, Croatia, offers an outpatient Early intervention programme for patients with psychotic disorders (RIPEPP), consisting of psychoeducational workshops and group psychodynamic psychotherapy. The aim of this study was to describe sociodemographic and baseline characteristics of the participants, in order to provide better understanding of this population, and to assist with the development of more effective therapeutic approaches. SUBJECTS AND METHODS: Since 2008, a total of 245 patients with first episodes of psychosis and their family members participated in the programme. They filled out several questionnaires within the framework of the programme evaluation, but for the purposes of this study, only data collected on sociodemographic questionnaire and the Health of the Nation Outcome Scales (HoNOS) are presented. RESULTS: Majority of the participants were male (66%), at the average age of 28 (SD=6.6), living with their parents (73.5%). Most of them finished secondary school (45.7%) but almost a quarter of the sample (23.7%) is currently studying at university. The average duration of untreated period was 101.60 days, with a median of 30 days. According to results of HONOS questionnaire, upon entry into the programme, the patients most often listed cognitive functioning (attention, concentration, memory) and professional issues (performance of work tasks and activities tied to work) as the most problematic areas. CONCLUSION: The findings of this study provide more detailed description of the beneficiaries of the RIPEPP programme, which can contribute to forming future programmes for the prevention of psychotic disorders.

Somatic comorbidities are independently associated with the poor health-related quality of life in psychiatric patients.

BACKGROUND: Despite the increased risk, the quality of somatic healthcare is lower for patients with mental illnesses. Currently dominant approach separates physical and mental, primary and secondary healthcare. Objective of our study was to explore whether somatic comorbidities are associated with a poor HRQoL independently of some sociodemographic and clinical factors. Majority of studies have explored particular somatic and psychiatric illnesses. Therefore we decided to access the problem from the general perspective of the universe of somatic and mental illnesses in the large psychiatric institution. SUBJECTS AND METHODS: This nested cross-sectional study was done during May 2016 at Psychiatric hospital Sveti Ivan, Zagreb, Croatia on the sample of 506 patients diagnosed with psychiatric illnesses (ICD-10: F00-F99). Key outcome was the lowest 25% results on the SF-36 General health sub-scale, indicating the worst HRQoL. Predictors were all detected somatic illnesses. By multivariate logistic regression we controlled different sociodemographic, vital and clinical factors. RESULTS: After adjustment for different sociodemographic and clinical factors, three somatic comorbidities remained independently associated with the worst HRQoL: endocrine, nutritional and metabolic diseases (E00-E90), diseases of respiratory system (J00-J99) and diseases of musculoskeletal system and connective tissue (M00-M99) CONCLUSIONS: Somatic comorbidities in psychiatric patients are associated with the poor HRQoL independently of different sociodemographic, vital and clinical factors and they should be treated seriously and integrally with mental aspects of HRQoL. Early comorbidities detection and adequate pharmacological and psychotherapeutic treatment, as well as the prevention of risk factors, may improve the quality of life and reduce morbidity and mortality of psychiatric patients.

Day Hospital Treatment as a Missing Link for Single Patients with Posttraumatic Stress Disorder (PTSD): a Preliminary Study.

BACKGROUND: The aim of this study was to examine the day hospital treatment outcome on severity of clinical manifestations, general neuroticism and coping mechanisms in patients suffering from chronic combat-related PTSD. SUBJECTS AND METHODS: The sample consisted of 38 consecutive patients admitted to the Day Hospital treatment of PTSD during one year observation period. The average age of the sample was 46.03 years. The patients completed 3 self-report measures upon admission to the hospital and upon discharge: The Mississippi scale for combat-related PTSD (M-PTSD), The Crown-Crisp experiential index (CCEI), and The COPE inventory. RESULTS: There was no significant change in the severity of clinical manifestations of PTSD, general neuroticism and coping mechanisms among the whole sample. However, compared to married participants and participants with children, single participants and those without children reported higher levels of anxiety when admitted to the hospital, but lower levels at discharge. In addition, patients without children reduced their avoidance behavior during the treatment. CONCLUSION: This preliminary study showed that single patients and those without children may benefit more from the day hospital treatment program. Our findings emphasize the importance of social support in the recovery process of severely traumatized persons, and may assist with the development of more effective therapeutic approaches.

Early intervention program for psychotic disorders at the psychiatric hospital "Sveti Ivan".

The Early intervention program for the first episodes of psychotic disorders (RIPEPP) at the Psychiatric Hospital "Sveti Ivan" in Zagreb encompasses patients hospitalized due to various psychoses (acute psychotic disorder, schizophrenia, schizoaffective and delusional disorder, bipolar affective disorder with psychotic symptoms) in the "critical period" of illness, i.e. within five years after the occurrence of the first symptoms. The RIPEPP Program consists of an in- and out-patient part, and includes psychotherapeutic and psychoeducative components as well as the administration of antipsychotics. The Psychotherapeutic part, conducted by psychotherapists - group analysts, comprises psychodynamic group psychotherapy for patients and for family members. The Psychoeducative part, led by cognitive-behavioral therapists, is carried out through educative interactive workshops for both patients and their family members. The paper describes the theoretical framework, as well as the professional, personnel, educative and organizational basis of the Program, the principles of evaluation and some experiences after five years of implementation.

Comparative study on gene tags of the neurotransmission system in schizophrenic and suicidal subjects.

Schizophrenia and suicidal behaviour are sever and complex mental disorders, largely determined by factors of inheritance. Both disorders present pathological changes in the catecholamine neurotransmitter system. The study was conducted on three groups; a group of subjects suffering from schizophrenia, a second compounded by individuals who attempted suicide and a third group of phenotypically healthy examinees. The blood samples of schizophrenic patients as of those who attempted suicide were obtained at the Psychiatric Hospital "Sveti Ivan" in Zagreb in the year 2004. Tests were conducted on the statistic relation between a total of 18 SNPs within three candidate-genes of the dopamine and adrenergic system (DRD4, SLC6A3 and ADRA2B) and the manifestation of schzophrenia and suicidal behaviour. Cases were genotyped by use of SNPlex system. Statistically significant differences were determined in the allelic frequency between the mentioned groups. Findings show a significant connection between 4 SNPs (ADRA2B rs749457, SLC6A3 rs464094, DRD4 rs11246226 and rs4331145) and schizophrenia, and 2 SNPs with suicidal attempt (ADRA2B rs1018351 i SLC6A3 rs403636). In addition, this is the first study that highlights the potential role/effect of polymorphisms in ADRA2B on the manifestation of schizophrenia, as on suicidal behaviour.

Differential diagnosis of psychotropic side effects and symptoms and signs of psychiatric disorders.

Diagnostic recognition and distinguishing of psychotropic side effects which are phenomenological Identical/similar to symptoms and/or signs of psychiatric disorders undergoing psychotropic treatment, is an integral element within the general diagnostic procedure. Unrecognising and undistinguishing of psychotropic-induced side effects from psychopathological phenomena and/or physical signs which are, according to relevant classification criteria, standard parts of psychiatric disorders, most frequently can cause increase the dose of the psychotropic medication, assigning of the unwarranted diagnoses, and/or addition of unnecessary medications. Some of the most frequent side effects that can be caused by the diagnostic difficulties and/or misjudgements of the phenomenological recognition and differentiating side effects from psychiatric symptoms and signs are: drug-induced akathisia, intensive anticholinergic pharmacodynamic effects including delirium, neuroleptic induced Parkinsonism, paradoxically antidepressants-induced worsening or re-emerging depression, acute dystonia and tardive dyskinesia and others. In conclusion, differential diagnosis of these side effects requires careful evaluation based on clinical experience and knowledge.

[Therapists' psychological problems when treating posttraumatic stress disorder]. / Psiholoske teskoce psihoterapeuta u radu s oboljelima od posttraumatskog stresnog poremecaja.

War experience in interaction with personality structure can have a traumatic effect and provoke various psychopathological responses and even disorders at the psychological level. PTSD is one of the possible psychopathological responses to war trauma, which provokes a range of different emotions in those working with such patients. The heterogeneity of the clinical aspect of the disorder, the comorbidity and social malfunctioning of the patients represent a frequent source of difficulties in the psychiatrist's work. The disorder brings about alterations at the somatic, psychological, social and occupational level of the affected individual, requiring a complex approach to treatment. The psychotherapeutic treatment of PTSD patients gives rise to different counter-transfer emotions at different stages of the therapeutic process. The therapist experiences fright, anger, guilt, frustration, and sometimes even a tendency to avoid the patient. His ability for empathy and understanding of the patient can be exhausted and become the cause of a reduced capacity for sympathy, a secondary traumatic stress and a vicarious trauma.

Influence of alcohol abuse of the father on the intensity of clinical picture of posttraumatic stress disorder.

The subject of the study is the influence of alcohol abusing father on the clinical picture of PTSD patient. The father plays an important identification role in the psychological development of his son. Therefore it is to be expected that an alcohol abusing father will become a (negative) role model for his son and that he will also later on in stressful situations try to reduce the anxiety and depression by consuming larger quantities of alcoholic drinks. The aim of the study is to find out whether there are differences in PTSD clinical picture in patients whose fathers abused alcohol and in those whose fathers did not have such problem. The participating patients were from the Psychiatric hospital "Sveti Ivan". Mississippi and Watson scales were applied, as well as a questionnaire named "Early traumas" from which the variable "alcohol abuse of the father" was selected. The analysis shows that the participants who in their family histories had fathers who abused alcohol developed a milder clinical picture of PTSD, i.e. they reactions to the stress later on were less sensitive compared to the control group of participants whose fathers did not abuse alcohol and whose clinical pictures of the disorder were more severe.

Anthropology and psychiatry.

In this paper anthropology and psychiatry are defined as well as their scientific area, their methods and research objectives; the high level of their mutual thematic and methodological complementarity has been emphasized. The sociocultural factors which are inherent in the area of cultural anthropology can affect mental health in a number of ways: by forming a certain personality type that is predisposed for a certain type of disorder, by an education model which increases the frequency of some disorders, by criticism and sanctions of a certain behaviour that is actually desirable from the point of view of mental health preservation, by supporting and rewarding a behaviour model that is harmful for mental health; by its complexity and, in some of the segments, by mutual contradictions they can cause mental disorders; by forming symptoms of mental disorders i.e. by a pathoplastic action through which they become an area of scientific interest of cultural psychiatry. Anthropology directs psychiatry towards creating preventive and therapeutic programs that accept the mutual influence and interconnectedness of socio-cultural conditions and the mental health status.