The Curious Role of PAI-1 in Severe Obstructive Sleep Apnea.

Plasminogen activator inhibitor-1 (PAI-1) has a significant role in fibrinolysis, atherogenesis, cellular senescence, and chronic inflammation. OSA (obstructive sleep apnea) leads to increased PAI-1 levels and the development of cardiovascular disease (CVD). The aim of this study was to determine the effects of CPAP therapy on coagulation parameters and PAI-1 in patients with severe OSA. This prospective, controlled study enrolled 57 patients who were newly diagnosed with severe OSA, 37 of whom had had good CPAP adherence after 6 months of therapy (usage of the device for at least 4 h per night), and their data were analyzed. The analysis showed a statistically significant increase in D-dimer values before CPAP therapy (415 (316.5-537.5)) vs. after therapy (499 (327-652)), p = 0.0282, and a decrease in fibrinogen values (3.665 ± 0.752 before CPAP therapy vs. 3.365 ± 0.771 after therapy, p = 0.0075)). PAI-1 concentration values before and after CPAP therapy did not differ significantly (17.35 ± 7.01 ng/mL before CPAP therapy vs. 17.42 ± 6.99 ng/mL after therapy, p = 0.9367). This study shows a tendency for fibrinolytic capacity to improve in patients with OSA after CPAP therapy, although PAI-1 levels did not differ significantly.

Impact of CPAP Therapy on the Autonomic Nervous System.

Obstructive sleep apnea (OSA) is a significant risk factor for cardiovascular disease (CVD) with increasing prevalence. An important mechanism of CVD development is a dysregulation of the autonomic nervous system (ANS). This prospective and controlled cohort study aimed to investigate ANS function in OSA including the response to long-term continuous positive airway pressure (CPAP) therapy by analyzing 24 h Holter electrocardiogram and 24 h Holter ambulatory blood pressure recording parameters. The study enrolled 57 patients who were newly diagnosed with severe OSA. After 6 months of CPAP therapy, 37 patients had a good therapy adherence (usage of CPAP device >4 h per night), and their data were analyzed. The difference in nocturnal diastolic blood pressure values before and after CPAP therapy reached statistical significance (76 (68-84) vs. 74 (63-80) mmHg, p = 0.0439). Lower nocturnal values after CPAP therapy of SDNN (101.5 vs. 95 ms, p = 0.0492) and RMSSD (29.5 vs. 26 ms, p = 0.0193) were found. An increase in diurnal spectral power (1742 vs. 2112 ms2, p = 0.0282) and a decrease in nocturnal spectral power (3256 vs. 2124 ms2, p = 0.0097), nocturnal VLF band (2493 vs. 1485.4 ms2, p = 0.0176), nocturnal LF band (638.7 vs. 473 ms2, p = 0.0097), and nocturnal HF band (234.9 vs. 135.7 ms2, p = 0.0319) was found. The results showed an imbalance of the ANS with a sympathetic predominance, especially during the night hours and in those with arterial hypertension. The impact of CPAP therapy on the improvement in ANS parameters was more pronounced at night, in men, and those with arterial hypertension.

The association of insomnia with long COVID: An international collaborative study (ICOSS-II).

OBJECTIVE: There is evidence of a strong association between insomnia and COVID-19, yet few studies have examined the relationship between insomnia and long COVID. This study aimed to investigate whether COVID-19 patients with pre-pandemic insomnia have a greater risk of developing long COVID and whether long COVID is in turn associated with higher incident rates of insomnia symptoms after infection. METHODS: Data were collected cross-sectionally (May-Dec 2021) as part of an international collaborative study involving participants from 16 countries. A total of 2311 participants (18-99 years old) with COVID-19 provided valid responses to a web-based survey about sleep, insomnia, and health-related variables. Log-binomial regression was used to assess bidirectional associations between insomnia and long COVID. Analyses were adjusted for age, sex, and health conditions, including sleep apnea, attention and memory problems, chronic fatigue, depression, and anxiety. RESULTS: COVID-19 patients with pre-pandemic insomnia showed a higher risk of developing long COVID than those without pre-pandemic insomnia (70.8% vs 51.4%; adjusted relative risk [RR]: 1.33, 95% confidence interval [CI]: 1.07-1.65). Among COVID-19 cases without pre-pandemic insomnia, the rates of incident insomnia symptoms after infection were 24.1% for short COVID cases and 60.6% for long COVID cases (p < .001). Compared with short COVID cases, long COVID cases were associated with an increased risk of developing insomnia symptoms (adjusted RR: 2.00; 95% CI: 1.50-2.66). CONCLUSIONS: The findings support a bidirectional relationship between insomnia and long COVID. These findings highlight the importance of addressing sleep and insomnia in the prevention and management of long COVID.

Borderline and Depression: A Thin EEG Line.

In everyday clinical practice, there is an ongoing debate about the nature of major depressive disorder (MDD) in patients with borderline personality disorder (BPD). The underlying research does not give us a clear distinction between those 2 entities, although depression is among the most frequent comorbid diagnosis in borderline personality patients. The notion that depression can be a distinct disorder but also a symptom in other psychopathologies led our team to try and delineate those 2 entities using 146 EEG recordings and machine learning. The utilized algorithms, developed solely for this purpose, could not differentiate those 2 entities, meaning that patients suffering from MDD did not have significantly different EEG in terms of patients diagnosed with MDD and BPD respecting the given data and methods used. By increasing the data set and the spatiotemporal specificity, one could have a more sensitive diagnostic approach when using EEG recordings. To our knowledge, this is the first study that used EEG recordings and advanced machine learning techniques and further confirmed the close interrelationship between those 2 entities.

Impact of CPAP Therapy on New Inflammation Biomarkers.

Obstructive sleep apnea (OSA) is a common sleep disorder leading to increased risk of developing cardiovascular diseases (CVDs) by supporting a low-grade chronic inflammation as one of the pathological mechanisms. The continuous positive airway pressure (CPAP) device is used as an effective treatment for moderate and severe OSA. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), white blood cell-mean platelet volume ratio (WMR), C-reactive protein-albumin ratio (CAR) and fibrinogen-albumin ratio (FAR) are new potential inflammatory biomarkers that are widely available and were shown to be possibly favorable screening or follow-up tools for moderate- or severe-grade OSA, as well as indirect indicators for cardiovascular risk. Our study evaluated the impact of CPAP therapy in patients with severe OSA and acceptable therapy adherence on NLR, PLR, WMR, FAR and CAR. Of 57 patients who were initially enrolled and had no exclusion criteria, 37 had a satisfactory CPAP adherence (usage of ≥4 h per night) after a minimum of 6 months of therapy. There was a statistically significant difference in NLR (2.122 ± 0.745 before therapy vs. 1.888 ± 0.735 after therapy) and FAR (86.445 ± 18.763 before therapy vs. 77.321 ± 19.133 after therapy) suggesting a positive effect of the CPAP therapy on chronic inflammatory states, thereby possibly reducing cardiovascular risk.

Internet Use among Patients with Schizophrenia and Depression.

BACKGROUND: The high and increasing prevalence of internet use in the general population and the significant burden of depression and schizophrenia urge us to investigate the patterns of internet use among patients with these illnesses. The aim of this study is to assess internet use and mental health-related internet use among patients suffering from schizophrenia and depression. METHODS: A total of 104 patients with psychosis and 105 patients with depression were surveyed to assess their internet use and mental health-related internet use. RESULTS: The majority of participants were internet users (87.6%), with 66.7% of internet users with psychosis and 71.4% of internet users with depression using it as a source of information on mental health. Participants with psychosis significantly more attributed the internet and mental health internet forums as helpful in coping with their mental illness and were more interested in the utilization of online mental health services than participants with depression. CONCLUSIONS: General internet use in patients with schizophrenia and depression corresponds with the internet use of the general population; however, they use it more often as a source of health information than the general population. Mental health service providers should offer more online interventions and treatment programs to patients with psychosis and depression, as our study suggests there is an unmet need for online mental health services for such patients.

Difference of Symptoms Networks in Early and Late Phase Schizophrenia; A Cross-Sectional Network Analysis.

OBJECTIVE: The functional remission or recovery of schizophrenia patients is a challenging task which relies on pharmacotherapy but also on the timing of psychotherapy and other therapeutic interventions. The study aimed to assess the difference in strength and structure of symptoms networks between early and late phase schizophrenia. Our secondary objective was to check whether the overall, positive, negative, and general symptoms severity change over the course of treatment and disorder. METHODS: This nested cross-sectional analysis combined the samples from two studies performed during 2014-2016 at University Psychiatric Hospital Vrapce, Zagreb, Croatia on the consecutive sample of men 30-60 years old diagnosed with schizophrenia, 85 of them in the early (≤5 years from diagnosis), and 143 in the late phase of the illness. The study was funded by the project: "Biomarkers in schizophrenia - integration of complementary methods in longitudinal follow up of FEP patients". RESULTS: Median (IQR) age of the participant in the early phase was 36 (32-45) years and in the late phase 44 (38-49) years. Patients in the early phase had significantly higher odds for being in the symptomatic remission compared to the patients in the late-phase schizophrenia (OR=2.11; 95% CI 1.09-4.09) and had 10% less pronounced negative symptoms. The global strength, density, and structure of the symptoms network were not significantly different between the two study groups. CONCLUSIONS: Negative symptoms severity change with the course of illness and differ from the early to the late phase of schizophrenia. However, the overall network of psychotic symptoms is relatively stable, and overall strengths or density and the partial relationship between particular symptoms do not change significantly. The observed worsening of negative symptoms is probably at least partially caused by the lack of clear guidelines and effective treatment options aimed specifically toward negative symptoms.

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries.

PURPOSE: There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes. METHODS: This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models. RESULTS: A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio. CONCLUSION: Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.

INSIGHT AND SELF-STIGMA IN PATIENTS WITH SCHIZOPHRENIA.

Poor insight and high level of self-stigma are often present among patients with schizophrenia and are related to poorer treatment adherence, poorer social function and rehabilitation, aggressive behavior, higher level of depression, social anxiety, lower quality of life and self-esteem. Reports on a relationship between insight and stigma are controversial. We examined the relationship of the level of insight and self-stigma in a sample of 149 patients with schizophrenia. Insight was measured with the Scale to assess Unawareness of Mental Disorder and self-stigma with the Internalized Stigma of Mental Illness. Results showed 88.6% of the patients to have high or moderate insight, with a mean value of 2.73. General insight showed the highest level (2.58) and insight in positive symptoms the lowest level (2.9). The self-stigma score in general was 2.13, with stereotype endorsement being lowest (1.98). According to study results, 77.1% of patients felt minimal or low self-stigma across all subscales, except for stigma resistance subscale. Statistically significant correlation was found between insight and four subscales of self-stigma, while no correlation was found for the stigma resistance subscale only. These results imply the need of individually tailored antistigma and insight promoting programs for patients with schizophrenia.

Prevalence of anxiety and depression in caregivers of Alzeheimer's dementia patients.

Alzheimer's dementia (AD) is the most common neurodegenerative disorder, which affects 30 million people worldwide. With aging of the population, it is becoming an increasing problem in Croatia. Alzheimer's dementia represents not only problem for the patient but affects the patients' caregivers as well. Caring for a patient with AD carries a significant physical, socioeconomic and psychological burden. Previous studies have shown an increased risk of physical and psychiatric illness. The aim of our study was to evaluate the prevalence and intensity of anxious and depressive symptoms in caregivers of AD patients treated at Vrapce University Psychiatric Hospital in Zagreb. The study included 30 caregivers of AD patients. Participants were included consecutively, during July and August 2010. The Croatian version of the Hospital Anxiety and Depression Scale (HADS) was used to assess the level of anxiety and depression in study participants. The mean level of anxiety and depression as measured by HADS was 10.46 +/- 4.26 and 8.03 +/- 4.08, respectively. A pathologic level of anxiety was found in 14 (46.7%) and pathologic level of depression as measured by HADS in 8 (26.7%) caregivers. This study showed that not only appropriate treatment of AD patients is necessary, but AD patient caregivers should also be provided due care and support.

Changing the structure of the hospitalized patients at the Psychiatric Clinic Vrapce.

INTRODUCTION: Psychiatric treatment in developed countries has significantly changed in the last few decades, with a significant shortening of the duration of hospitalization. Numerous West European countries are undertaking health system reforms to improve treatment efficiency. OBJECTIVE: The aim of the study was to present the structure of hospitalized patients according to diagnostic categories of International Classification of Diseases and Related Health Problems - 10th Revision (ICD-10), and average duration of hospitalization from 2001 till 2010. METHODS: Data was collected from hospital medical charts for the period from 2001 till 2010 on the number of hospitalized patients, diagnosis and duration of hospitalization. RESULTS: Number of hospitalized patients increased by 27% (6309 vs. 8032). Average duration of hospitalization decreased for 45.1% (72.3 vs. 39.7 days), while the number of hospitalized patients decreased from 1284 (20.4%) in 2001 to 995 (12.4%) in 2010, the number of patients hospitalized because of depressive disorder increased from 309 (4.9%) in 2001 to 994 (12.4%) in 2010. The number of patients hospitalized because of enduring personality changes increased from 104 (1.7%) in 2001 to 449 (5.6%) in 2010. CONCLUSION: In the last decade the number of hospitalized patients suffering from schizophrenia at the Psychiatric Clinic Vrapce decreased, while the number of those suffering from depression and enduring personality change increased. The number of hospitalizations in the observed period increased overall. Observed changes can be explained by new therapeutic approaches, but also by objective social and economic factors and organization of the healthcare system.

Effects of cannabis use on age at onset in schizophrenia and bipolar disorder.

BACKGROUND: Cannabis use may decrease age at onset in both schizophrenia and bipolar disorder, given the evidence for substantial phenotypic and genetic overlap between both disorders. METHODS: 766 patients, aged 16 to 65 years, were assessed with the Composite International Diagnostic Interview (CIDI) for substance abuse/use. 676 subjects were diagnosed with schizophrenia and 90 subjects with bipolar disorder. The influence of cannabis use on age at onset in both schizophrenia and bipolar disorder was examined using regression analysis. RESULTS: Cannabis and other substance use was more frequent in patients with schizophrenia compared to the bipolar group. Both cannabis use and a schizophrenia diagnosis predicted earlier age at onset. There was a significant interaction between cannabis use and diagnosis, cannabis having a greater effect in bipolar patients. Age at onset in users of cannabis was comparable in both diagnostic groups whereas bipolar non-users were significantly older than schizophrenia non-users at onset. CONCLUSION: Cannabis use may decrease age at onset in both schizophrenia and bipolar patients and reduce the effect of diagnosis. This is consistent with the view that cannabis use may unmask a pre-existing genetic liability that is partly shared between patients with schizophrenia and bipolar disorder.

Problems in the current psychiatry residency training program in Croatia: residents' perspective.

The aim of this study is to evaluate the quality of the current residency training in psychiatry in Croatia using parameters of professional achievements of residents and their subjective evaluations of the residency training that is being offered. 66 residents from 15 Croatian psychiatric hospitals, clinics and wards in general hospitals fulfilled the questionnaire constructed to obtain information about the profile of psychiatry residents in Croatia, parameters of educational quality and evaluation of offered residency training as seen by residents. We interviewed 89% of all residents that had a trainee status in September and October 2006 in Croatia (66 out of 74). Study results indicate that Croatian psychiatry residents are derived from a pool of very good medical students and the majority is engaged in postgraduate studies and research activities and shows high interest in specific psychiatric fields such as psychotherapy and clinical psychiatry. Most of participants are only partially satisfied with the residency training that is being offered and feel that most problems reside from the lack of practical psychotherapy, the inefficiency of the mentorship system and the lack of funding resources. The results of this study revealed the major problems of psychiatry residents in Croatia. Following those results, we will perform the study that would include mentors and supervisors from different Croatian psychiatric centers. That could enable the development of specific interventions with aim to improve current residency training in Croatia.

Characteristics of patients who committed suicide during hospitalization in Psychiatric Hospital "Vrapce" in the period 1996-2006.

The aim of this study was to determine the characteristics of psychiatric inpatients who committed suicide in the Vrapce Psychiatric Hospital with respect to clinical, ethical, and legal context. The study included all patients hospitalized in the Vrapce Psychiatric Hospital between 1 January 1996 and 31 December 2006 who committed suicide (n = 25). The suicide rate in the observed period was 32.9 per 100.000 (suicide coefficient, 50), which is similar that in general population. Based on the characteristics of hospitalized patients who committed suicide, we obtained a typical profile as follows: a middle-aged person, single, unemployed, repeatedly hospitalized, with schizophrenia and a history of suicide attempts, committing suicide using a violent method after more than three weeks of hospital treatment. If further prevention of hospital suicide will be treated as a legal rather than medical issue, the hospital atmosphere would be totalitarian rather than therapeutic. The success of psychiatric treatment is the perception of both of these aspects of suicide as well as their efficient balancing.

Two-year rehospitalization rates of patients with newly diagnosed or chronic schizophrenia on atypical or typical antipsychotic drugs: retrospective cohort study.

AIM: To determine if atypical antipsychotic agents reduce the rehospitalization rates of patients with newly diagnosed or chronic schizophrenia in comparison with typical antipsychotic drugs. METHODS: From January 1, 2003, to December 31, 2004, we retrospectively compared two-year rehospitalization rates of 135 patients with newly diagnosed schizophrenia and 398 patients with chronic schizophrenia (62% and 65% men, respectively), who were initially discharged from Vrapce Psychiatric Hospital, Zagreb, with the prescription of atypical (olanzapine, risperidone or clozapine) or typical (haloperidol or fluphenazine) antipsychotic treatment between January 1, 2002 and December 31, 2002. Time-to-readmission was determined with Kaplan-Meier formula for survival analysis. RESULTS: In the two-year follow-up, 52 (39%) newly diagnosed patients and 197 (47%) patients with chronic schizophrenia were rehospitalized. No significant differences in time-to-rehospitalization were observed with respect to the type of medications in patients with newly diagnosed schizophrenia (P=0.378) or patients with chronic schizophrenia (P=0.531). CONCLUSIONS: Rehospitalization rates of patients who were prescribed atypical antipsychotic drugs were similar to those of patients who were prescribed typical antipsychotic drugs for both the group with the first psychotic episode and group with chronic schizophrenia.

Dynamic in prescribing antipsychotic drugs during five year period (2001-2005) in the Psychiatric Hospital Vrapce, Zagreb, Croatia.

Aim of this study was to determine changes in prescribing antipsychotics during 5 year period in Psychiatric Hospital VrapEe. Data about type of antipsychotic medication, ward and gender were collected for all patients receiving antipsychotics on 1st of October. During 5 year period decrease in prescribing classical antipsychotics was observed while prescribing of atypical antipsychotics has shown increase. There was an increase in number of patients treated with combination of antipsychotics, while number of patients treated with clozapine remained the same. It was noticed that female patients were more often treated with atypical antipsychotics. Data for forensic and emergency ward was analyzed separately and trends similar to hospitals were noticed here. Rationalizing use of antipsychotics can decrease cost of treatment, decrease negative effects of antipsychotics and consequently improve the treatment. Through systematic studies of this type positive progress and changes in the prescribing of antipsychotics are possible.

[Intoxication with henbane]. / Intoksikacija bunikom.

Henbane, Hyoscyamus niger, is a hallucinogenic plant, widely spread and easy accessible, which contains anticholinergic substances. Ingestion, intentional or accidental, can provoke serious worsening of psychophysical state and can cause even death. Intoxication resembles the one with atropine. Symptoms like mydriasis, tachycardia, arrhythmia, agitation, convulsion and coma can appear. Diagnosis is made by clinical symptomatology and history. Therapeutic acts include stomach lavage, supportive therapy and physostigmine as a specific antidote. Prognosis is usually good.