Prescribing practices in Southeastern Europe - focus on benzodiazepine prescription at discharge from nine university psychiatric hospitals.

There is much concern about the widespread long-term use of benzodiazepines. Our manuscript addressed its use in the region of Southeastern Europe, which seems extensive, but insufficiently explored. At nine university psychiatric hospitals (Croatia, Macedonia and Serbia), we retrospectively analyzed discharge summary documents to find the prevalence of discharge benzodiazepine prescriptions and the prescribed benzodiazepine doses. This study included 1047 adult subjects and showed that 81.9% of them had benzodiazepines prescribed in the discharge summary document, with high mean daily dose of around 5mg lorazepam equivalents. Factors associated with the prescriptions were exclusively clinical factors (diagnosis of schizophrenia spectrum disorders, more lifetime hospitalizations, psychiatric comorbidity, co-prescription of antidepressant or mood stabilizer, shorter duration of the hospitalization), while socio-demographic factors were not found to influence benzodiazepine discharge prescriptions. Similarly, factors which influenced the prescription of higher daily benzodiazepine dose were more lifetime psychiatric hospitalizations and co-prescription of antidepressant or mood stabilizer, as well as the diagnosis of mental/behavioral disorders due to substance use and co-prescribed antipsychotic. Our data are emphasizing an urgent need for guidelines and improved education of both health care professionals and patients, in order to prevent long term benzodiazepine (mis)use and related side-effects.

Prevalence and Correlates of Aggression and Hostility in Hospitalized Schizophrenic Patients.

This study is aimed at identifying the incidence as well as clinical and socio-demographic correlates of aggression in hospitalized schizophrenic patients. We prospectively recruited participants with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnosis of schizophrenia presenting to the Clinic for Psychiatry during a 2-year period. We used the Modified Overt Aggression Scale to assess the aggression and Positive and Negative Syndrome Scale (PANSS) to assess the clinical characteristics of participants. One out of three patients with schizophrenia (31%) was aggressive and hostile at the time of presentation. Socio-demographic variables (such as gender, age, duration of illness, and number of hospitalizations) were poor predictors of aggression for schizophrenic patients. The level of aggression was not associated with the clinical characteristics in aggressive and hostile hospitalized schizophrenic patients. However, there was a weak negative association between the level of aggression and the PANSS Negative Scale ( p < .01). In conclusion, socio-demographic variables and clinical characteristics seem to be not such good predictors of aggressive behavior in hospitalized schizophrenic patients. Nevertheless, the results of our study contribute to the understanding of the prediction and treatment of aggression in a well-defined cohort of schizophrenic patients.

Psychiatric consequences of stress after a vehicle accident.

BACKGROUND: Vehicle accidents are a common cause of disease and death among people over 30 years of age. Essentially, reaction to stress due to the vehicle accident does not differ from the reaction to other stress factors. There are still no uniform viewpoints about the kind of sequels and their percentage representation after vehicle accidents. SUBJECTS AND METHODS: The research was provided as a prospective study, included 150 subjects who had vehicle accident minimum 2 years prior to the examination. A questionnaire adjusted to the needs of the research and a battery of psychological tests was used. RESULTS: Affective disorders occurred in 35.33% of subjects, 65% of persons suffer from travel anxiety, 9% of the total number of examinees doesn't drive any more, 65% have somatisational dysfunctions of the vegetative nervous system, while the posttraumatic stress disorder is present in 36% of subjects. CONCLUSION: In 87.4% of persons psychiatric consequences last over two years. Long term consequences in 60% of subjects occur as a combination of multiple psychiatric disorders, so the posttraumatic stress disorder and affective disorders never occur one at a time.