Correlation of levels of depressiveness and choice of elective subjects in medical students.

The aim of this research was to establish if a correlation exists between the choice of an elective subject, namely subjects "Depression" and "Diabetes", and levels of depressiveness in medical students. Three groups of third year medical students attending School of medicine, Rijeka University, were tested for the level of depression using Beck's self-evaluation scale. The groups consisted of 30 non-randomly selected students that had enrolled elective subject "Depression" and 29 non-randomly selected students that had enrolled elective subject "Diabetes", and the third group of 30 randomly selected third year medical students that had enrolled none of the previously mentioned elective subjects. Median age of participants in this research was 25.24. The results showed no statistically significant difference in overall level of depressiveness among the groups. By testing for the difference between group pairs, there was a statistically significant difference between depressiveness in students attending "Depression" and "Diabetes", the latter being significantly more depressed (M = 8.30 in "Depression" group; M = 11.41 in "Diabetes" group; p = 0.04). In total there were 33 males and 56 females that participated in this research. Gender difference was also tested, and there was no statistically significant difference between sexes among groups. The difference was found only within the group of students attending "Depression" elective subject, where females scored significantly higher on Beck's questionnaire (z = 2.26; p = 0.03). The analysis of difference between items of the Beck's questionnaire showed statistically significant difference in the item "Feeling of rejection", where students attending elective subjects other then "Depression" scored significantly higher; differences in the items "Urge for punishment" and "Suicidal tendencies" were also found between "Diabetes" and "other elective subjects" group, in favor of "Diabetes" group; in the item "Weight loss" students attending "Diabetes" elective subject scored significantly higher then their peers in both other groups. The results indicate the possibility of a protective role of psycho-educative component provided to the students attending elective subject on depression within medical school environment, that has repeatedly been shown to be stressful and demanding and is beneficial for the onset of depressive disorders.

Posttraumatic stress disorder and depression as comorbid disorders.

INTRODUCTION: Depression is the most frequent disorder of today. It is unique for the fact that it can become a comorbid illness with almost any other psychiatric disorder. Premorbid depression is also a risk factor for the development of PTSD, while at the same time traumatic experience is a risk factor for the development of depression. These facts show us that a close connection between these two diagnostic entities exists. Aim of this research was to analyze the levels of depressiveness in patients that were hospitalized and patients that were treated in the Day hospital. Also, to establish the connection of age, time spent in combat (war), length of treatment and number of hospitalizations with the results from the Beck's depression inventory. SUBJECTS AND METHODS: Participants were divided into two groups, 36 patients that were treated for PTSD in a hospital setting and 64 patients that were treated in the Day hospital. Participants completed Beck's self-evaluation inventory for depression, as it assesses the degree of depression. RESULTS: Two groups did not differ regarding to age, time spent in combat (war), the length of treatment and level of depressiveness assessed by Beck's depression inventory. Score on Beck's depression inventory was significantly positively correlated with the age of participants and the number of hospitalizations. Older participants and participants that were hospitalized more often score higher on Beck's depression inventory. CONCLUSION: Results show that there is no difference between the two groups of participants of differing levels of depressiveness, but depression most often presents as severe depression in both groups of participants. Older participants and participants that were hospitalized more often are more depressed. This research points to the fact that it is necessary to treat PTSD and depression at the same time, because parallel treatment of these comorbid disorders leads to a decrease of the rate of suicide, due to the fact that depression is often the leading cause of suicide.

Aspects of sexual self-perception in schizophrenic patients

Objective: Self-perception is a complex, dynamic system and sexual self-perception’s only one of the items in that complex system. Our goal was to establish whether the differences in sexual self-perception between schizophrenic patients and healthy individuals exist, and to establish possible differences in sexual self-perception between acute and chronic schizophrenic patients. Method: Bezinovic’s test for sexual self-perception was used because it assesses multiple aspects of sexual self-perception and provides thorough insight of that part of self. Results: Results revealed that schizophrenic patients, compared to healthy individuals, scored significantly higher on the aspects of negative emotionality and sexual incompetence and significantly lower on the aspect of sexual satisfaction. No statistically significant differences were established between acute and chronic schizophrenic patients. Conclusions: It can be concluded that the conscious part of libido organization in schizophrenic patients exhibits proper consciousness of own sexuality, normal readiness for sexual activity, normal sexual adventurism, significantly higher negative emotionality and sexual incompetence and significantly lower sexual satisfaction (AU)

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Activation of ERK and JNK MAP kinases in optic nerves of rats exposed to global cerebral ischemia.

OBJECTIVES: To determine the influence of global cerebral ischemia on the activation of extracellular-regulated kinases (ERK) and c-Jun N-terminal kinases (JNK) in optic nerves of rats exposed to different reperfusion periods. MATERIALS AND METHODS: Transient global cerebral ischemia (20-min duration) was induced by the four-vessel occlusion method. After different reperfusion periods (5 and 10 min; 1; 6 and 12 h after ischemia), optic nerves were extracted and ERK and JNK activation signals were determined by Western immunoblot analyses. RESULTS: The activation signals of ERK and JNK were detected within first 10 min of reperfusion, but striking activation for both enzymes was found 1 h after ischemia. After a transient decrease, the activation of ERK returned to peak level after 12 h of reperfusion in the second wave of kinase activation. In that period, a slight increase of JNK activation was registered. CONCLUSION: Our results demonstrated for the first time that ERK and JNK were activated in rat optic nerves during early and later periods of reperfusion, suggesting their potential active role in the response of cerebral white matter tissue to ischemic injury.

Dimensions of human spirituality, layman understandings of health and limits of medicine.

The essence of human uniqueness and what is special about humans is spirituality. What is unique to every human being is his: language, sociability, politic, science, art, technical and working attitudes, playing games, fun and laughter, as well as religiosity and ethical attitudes. All of these dimensions are based upon spirituality or even the human spirit. This paper aims to relate all these dimensions of human spirituality to the sick person and establish to what extent that person is imbued with them and whether he can rely on them. Furthermore, this paper attempts to shed some light on the limits of medicine, especially as seen by Ivan Illich. In the end we are left with a series of questions, and possibly with an indisputable fact that the person who is suffering physically or mentally is "saved" by his most amazing unique trait--his religiosity.

NA+, K+-ATPase activity in the brain of the rats with kainic acid-induced seizures: influence of lamotrigine.

OBJECTIVE: Kainic acid (KA) is used as an experimental agent which produces convulsions and neurotoxic lesions. Lamotrigine (LTG) is an antiepileptic drug, a glutamate release inhibitor, with action at the neuronal voltage-gated sodium channel. The aim of the present study was to investigate the Na+-K+-ATPase activity in the hippocampus and cortex of rats with KA-induced convulsions. Further, this study was also designed to investigate the influence of the LTG pre-treatment on the mentioned hippocampal and cortex changes. MATERIALS AND METHODS: The study was carried out on Hannover-Wistar rats. Na+, K+-ATPase activity from hippocampal and temporal cortex tissue was determined two hours after a single subcutaneous KA (8 mg/kg) injection as well as on the third or the fifth experimental day. LTG (30 mg/kg i.p.) was used one hour before KA application and during the next two or four consecutive days. All animals of KA and KA+LTG groups were observed during the first 2 hours after KA application and their behavior was noted. Only animals with characteristically KA-induced behavioral changes observed were used in the study. KA typical behavioral changes were confirmed with electroencephalography. RESULTS: After KA application, Na+, K+-ATPase activity was significantly inhibited. Na+-K+-ATPase activity inhibition in the hippocampus of the LTG pretreated rats on the fifth experimental day was statistically less pronounced than in KA treated rats. The LTG pretreatment showed also a protective effect on the Na+-K+-ATPase activity in the rats' brain cortex. CONCLUSION: KA systemic application induced Na+, K+- ATPase activity inhibition in the rat hippocampus and cortex and LTG pre-treatment showed a partially protective effect on the enzyme activity.

Lithium treatments: single and multiple daily dosing.

OBJECTIVE: To review the feasibility and effectiveness of single daily dosing of lithium in patients with affective disorder and to discuss advantages and disadvantages of this schedule of administration. METHOD: A comprehensive search of the literature was conducted using a combination of electronic databases and a search of reference lists and relevant journals. English-language articles were selected for the review if they discussed the issues comparing multiple and single daily dosing schedules of lithium. RESULTS: We found 9 comparative studies. Single daily dosing of lithium causes transient higher peak lithium concentrations; however, no comparative study revealed a significant difference in side effects between multiple and single daily dosing groups. Numerous reports concluded that taking lithium in a single dose prevents, or at least limits, the increase in urine output (and the reduction of osmolality) and subsequent thirst. There is no evidence that a single lithium dosing schedule preserves glomerular function. CONCLUSION: According to the presented data, it could be reasonable to use lithium as a single evening dose in patients who can tolerate this schedule because no studies have suggested any benefit from administration of multiple daily doses. Possible advantages of single daily dosing, especially in improved compliance, could not be veiled by disadvantages of transient and mild postabsorptive side effects.

The influence of daylight exposure on platelet 5-HT levels in patients with major depression and schizophrenia.

Platelet serotonin (5-HT) can be used as a limited, peripheral model for the central 5-HT synaptosomes. Altered platelet 5-HT concentrations have been associated with psychiatric disorders like depression and schizophrenia. The aim of the present study was to compare platelet 5-HT concentrations during long, medium and short period of natural daylight exposure in a large number of medication-free male and female schizophrenic and depressed patients and sex-matched healthy controls. Platelet 5-HT concentration was determined spectrofluorimetrically in 240 (97 female, 143 male) schizophrenic and 258 (153 female, 105 male) nonpsychotic, nonsuicidal depressed medication-free patients and 328 (149 women, 179 men) healthy subjects during periods with short (<12), long (>12) and medium (average 12) hours of the natural daylight. Platelet 5-HT concentration was significantly lower in women compared to men in all groups. Healthy male subjects had significantly higher (p=0.011) platelet 5-HT concentrations during long compared to medium period. There were no significant differences (p>0.05) in platelet 5-HT concentration between different periods in healthy women. The significant increase in platelet 5-HT values were found in female (p=0.01) and male (p=0.029) depressed patients during long compared to short period. There were no significant associations between platelet 5-HT concentrations and different periods in both male and female schizophrenic patients. The results indicate the sex-related differences in the serotonergic system. The alterations of platelet 5-HT concentrations, observed across period with different durations of daylight exposure, point to a direct or indirect effect of light on peripheral 5-HT system that could be related to different sensitivity of the pineal gland to light and/or melatonin influence on 5-HT metabolism.

Psychopharmacotherapy and spirituality.

Although the connection between spiritual and physical has been acknowledged since the oldest of human civilizations and emphasized in almost all of religions, It has taken a lot of time for that connection to gradually recover its lost meaning. As it is evident that many diseases and illnesses can not be explained purely by physical causes nor treated with purely physical methods there is a growing interest in spirituality and its usability in the treatment of various diseases and states, as well as in everyday life. Despite the fact that a sense of positive, nourishing and healing power of faith is deeply rooted in every religion, objective and empirical research of that connection has been avoided for centuries, and those studies which were conducted are only rudimentary, on the outskirts of empirical science. Scientific literature regarding spirituality and mental health points to a conclusion that spirituality and faith are positively correlated with positive therapeutic outcome and the possible explanation for that can be found in the fact that spirituality and religiosity can satisfy some of the basic needs of psychiatric patients. Efficacy of psychiatric treatment improved with the introduction of psychotropic medicaments and psychotherapeutic techniques, but the outcome is still not satisfying because relapse, recidivation and discontinuation of therapy occur very often. On the other hand, spirituality and religiosity play a very significant role in the healing process because they provide people with strength and will to fight their problems and disease itself. Psychopharmaceuticals are evidently irreplaceable in the therapy of mental disorders, but they are only one of the segments of the overall therapy. In order to adequately answer to the spiritual and religious needs of their patients, psychiatrists, psychologists and related health care professionals are faced with the need for expanding scientific concepts which served as the basis for development of many psychiatric methods and techniques.

Hereditary predisposition and sexual self-concept in schizophrenia.

OBJECTIVE: Aim of this research was to establish possible differences in sexual self-perception among acute and chronic schizophrenic patients, taking into consideration their hereditary predisposition. METHODS: Two groups of schizophrenic patients were analyzed, consisting of 100 acute and 100 chronic schizophrenic patients, treated at the Psychiatric clinic Rijeka, in the period 1998-1999, taking into consideration their hereditary predisposition and influence of that predisposition on seven aspects of sexual self-perception: sexual self-scheme, sexual consciousness, readiness for sexual action sexual adventurism, level of negative emotions towards one's sexuality, perception of one's sexual self-competence, sexual satisfaction. RESULTS: Results show that hereditary predisposition in chronic schizophrenic patients has a negative effect on some of the aspects of sexual self-perception: sexual self-scheme and sexual satisfaction. Therefore, patients with hereditary predisposition achieve lower results than those without hereditary predisposition. CONCLUSION: We can conclude that hereditary predisposition negatively influences certain aspects of sexual self-perception in chronic schizophrenic patients, and that it does not influence aspects of sexual self-perception in acute schizophrenic patients.

Mental disorders and metabolic syndrome: a fatamorgana or warning reality?

BACKGROUND: There has been a growing interest in the effect that comorbid mental and somatic disorders may have on each other. Metabolic syndrome is an important risk factor for the development of diabetes mellitus, cardiovascular disease and premature mortality. OBJECTIVES: To examine the association between various mental disorders (schizophrenia, schizoaffective disorder, bipolar disorder, depression, post-traumatic stress disorder and other mental disorders) and metabolic syndrome and discuss the possible pathophysiologic mechanisms that may link specific mental disorders and metabolic syndrome. METHOD: A MEDLINE search, citing articles from 1966 onward, supplemented by a review of bibliographies, was conducted to identify relevant studies. Criteria used to identify studies included (1) English language, (2) published studies with original data in peer-reviewed journals. RESULTS: Clinical investigation of the metabolic syndrome in patients with mental disorders, except schizophrenia, has been surprisingly scarce. Metabolic syndrome was reported in 19-63% of schizophrenic patients, in 42.4% of patients with schizo-affective disorder, in 24.6-50% of bipolar patients, in 12-36% of the patients with recurrent depression and in 31.9-35% of patients with combat posttraumatic stress disorder. CONCLUSION: Metabolic syndrome can contribute to significant morbidity and premature mortality and should be accounted for in the treatment of mental disorders. No definite or reliable insight into the pathophysiological link between metabolic syndrome and mental disorders is available.

Acute brain syndrome as a consequence of the Cronkhite-Canada syndrome.

BACKGROUND: Cronkhite-Canada syndrome is a very rare illness and psychical disturbances developed as a consequence of this illness are very rarely described. That is the case because majority of the symptoms of this syndrome are associated with the polyposis of the gastrointestinal tract. AIM: The aim of this case report is to link the development of acute brain syndrome with this rare syndrome. PATIENT: The patient was two times treated under the diagnosis of Cronkhite-Canada syndrome in the clinics of internal medicine in Rijeka and Zagreb, and then in the Psychiatric Clinic in Rijeka under the diagnosis of acute brain syndrome (F05.0). RESULT: Therapy with a typical antipsychotic (haloperidol) and corresponding internistic treatment gave results very fast and calmed acute delirium. CONCLUSION: Typical antipsychotics are efficient in the treatment of the acute brain syndrome caused by Cronkhite-Canada syndrome. Acute brain syndrome is caused solely by the lack of electrolytes and other important nutrients because of a malabsorption syndrome, conditioned by a diffuse polyposis of intestines.

Update of suicide trends in croatia 1966-2002.

OBJECTIVE: To analyze trend the suicide rates in Croatia during the pre-war period of socialistic Yugoslavia (1966-1990), war period in the former Yugoslavia (1991-1995) and the post-war period of Croatian independence and democratization (1996-2002). METHOD: Using official suicide statistics, this study examined suicide rates in Croatia over a 36-year span (1966 to 2002) as a function of gender, age, marital status, time, war and social changes. Suicide rates were displayed graphically and compared with some neighbouring countries (Slovenia, SCG, Hungary and Italy). RESULTS: During the period of socialistic Yugoslavia, suicide rate in Croatia was constantly increasing with small variations. During the war time suicides with firearms were significantly increased. Since 1993 (the period of independence and democratization) there has been a trend of evident decrease in total suicide rate. CONCLUSION: This study demonstrated that Croatia has still had high suicide rates with declining trend since 1993, probably related to democratization, more national, religious and cultural rights, better availability of SSRIs and systemic campaign for education of general practitioners for early recognition and treatment of depressive disorders.

Influence of depression on patients satisfaction with the outcome of microsurgical "key-hole" vs classical discectomy: prospective matched-cohort study.

AIM: To assess the influence of depression on patients' satisfaction with lumbar discectomy performed by two different surgical techniques. METHODS: A prospective matched-cohort analysis of classical lumbar discectomy following static imaging (n = 45) and microlumbar "key-hole" discectomy after dynamic CT/myelography (n = 55) was performed. The outcome was independently assessed using Prolo economic/activity (E) and functional/pain (F) scale, and depressiveness according to Hamilton rating scale. Patients without improvement on the Prolo scale were classified as failed back surgery syndrome, and with a Hamilton score 17 as depressive. RESULTS: The groups were well matched by age, sex, clinical presentation and incidence of depression. In the "key-hole" group, both activity and pain outcome were better than in the classical technique group (median E score (range) = 4 (2-5) vs 3 (2-4), p = 0.002, median F score (range) = 4 (2-5) vs 4 (1-5), p = 0.008). Eighteen patients were classified as failed back syndrome, 6 in the "key-hole" group, and 12 in the classical group (z = 3.16, p = 0.075). The incidence of failed back syndrome among non-depressive patients was significantly lower in "key-hole" group (2/55 patients vs 8/45, z = 2.345, p = 0.009). Occurrence of unsatisfactory results among depressive patients was very similar in both groups (4/55 patients vs 4/45, z = 0.296, p = 0.384). CONCLUSION: Introduction of functional imaging and "key-hole" technique decreased incidence of failed back syndrome among non-depressive patients. Unsatisfactory outcome among depressive patients was unrelated to the imaging and surgical technique. Connection between depression and failed back syndrome, although detected, remains unclear and must be further investigated.