Changing attitudes of high school students towards peers with mental health problems.

BACKGROUND: Stigma refers to the undesirable characteristics linked to mental illness and the adverse cognitive and behavioral consequences. Stigma causes a spiral of alienation and discrimination, leading to social isolation that diminishes chances for recovery. There is a great need for antistigma programs in order to decrease stigma related to persons with mental health problems. The antistigma program was initiated in schools of Serbia with the aim to address and decrease discrimination of adolescents with mental disorders. SUBJECTS AND METHODS: Sixty-three students from high schools voluntarily participated in the program. The effect of the program on the attitudes of students was evaluated by the Opinion about Mental Illness Questionnaire given to adolescents prior to its implementation and six months afterwards. RESULTS: Social discrimination and the tendency towards social restriction were reduced, while, at the same time, social awareness of mental health-related problems was increased among young people six months after program implementation. The results obtained clearly indicate positive changes in adolescents' attitudes and demonstrate a need for further educational activities regarding stigma and mental disorders. CONCLUSION: Stigma and discrimination reduction programs for adolescents are aimed at achieving a change of their attitudes toward the mental health problems of their peers and themselves through organized education. Our program demonstrates the necessity for youth participation in mental health services and system, and antistigma actions are seen as important aspects.

[Sexual dimorphism and specificities of psychopharmacological treatment in women].

The scope of gender related differences observed in mentally ill persons provides a major source of inference about the role of gonadal steroids in brain function and behavior. Reported gender dimorphism in psychiatry includes the following: prevalence of certain mental disorders specific to female gender, phenomenology and treatment characteristics, i.e. response to the applied psychopharmacotherapy. Structural and functional relationship between the hormonal system and central nervous system is closely correlated with vulnerability to various psychopathological disturbances in biologically different stages in women. It has been observed, for instance, that the association of gonadal steroid activity with serotonin is relevant to mood change in premenstrual and postpartum mood disturbances. Gender related hormonal fluctuations may cause or be correlated with the development of several gender-related psychopathological disturbances. The aim of this article is to review the literature concerning gender-related specificities of psychopharmacological treatment of some of the most important mental disorders in women, such as affective disorder in menopause, premenstrual syndrome and postpartum mood disorders.

[Adjustment disorders in hospital treated adolescents: a follow-up study].

INTRODUCTION: Adjustment disorders represent a frequent diagnostic entity especially among adolescents. They involve a wide spectrum of various emotional and behaviour problems. OBJECTIVE: The aim was to investigate characteristics of diagnostic category known as adjustment disorders among hospital treated adolescents for the first time at the Clinical Department for Children and Adolescents of the Institute of Mental Health in Belgrade, during five consecutive years, as well as to investigate the outcome of the disorder in follow-up period. METHODS: We conducted a retrospective investigation of the first time hospital treated adolescents from Belgrade with discharge diagnosis of adjustment disorders during 2000-2004. The follow up was conducted 5-10 years after a first discharge from the hospital. RESULTS: During the investigated period 75 adolescents from Belgrade were hospitalized for the first time with diagnosis adjustment disorder. From the studied patients the main sample was formed that included 24 (32%) males and 51 (68%) females. After 5-10 years a follow-up of 52 patients was conducted (sample at follow-up) which included 16 (30.77%) males and 36 (69.23%) females. Of the main sample, 70% of the patients were under follow-up. After the first hospitalization 58% of adolescents continued with further psychiatric treatment, either as rehospitalized or out-of-hospital patients. CONCLUSION: Our findings showed that 38% of adolescents under follow-up for 5-10 years after the first discharge from hospital with the diagnosis adjustment disorders had multiple hospitalizations. The outcome of the disorder among these patients was the worst, because three-quarters of the patients were rediagnosed in the follow-up period with a new psychiatric disorder, often from psychotic spectrum.

[DiGeorge syndrome: a case report].

INTRODUCTION: DiGeorge syndrome is a genetic disorder caused by deletion of chromosome 22. The main features are congenital heart disease, absence or hypoplasia ofthymus (with consecutive immunodeficiency and infections), hypoparathyroidism with consecutive hypocalcaemia, gastrointestinal problems, Delayed psychomotor development, abnormalities of head and face, tendency to develop seizures and psychiatric disorders. Syndrome can be detected prenatally, or during early development, which is of great importance for preventive and therapeutic measures. Death rate is high during the first year of life, mostly because of congenital heart disease. With prompt diagnosis and treatment most of the children can survive to adulthood, but they are children with special needs requiring continual care and supervision (because of metal retardation, seizures, neurological and psychiatric disorders). CASE OUTLINE: A seven-year-old boy underwent surgical correction of congenital heart disease soon after the birth. Since the age of four years he developed seizures, partially controlled by antiepileptic therapy. Entering the seventh year of age he displayed severe auto and heteroaggressive behaviour. His condition has improved by the introduction of intensive psychiatric and defectological treatment, and daily counselling with his mother the child improved in the sense of calming down, better social communication and acquiring some self-help specific skills. CONCLUSION: Symptoms of DiGeorge syndrome can be detected soon afterthe birth, especially that concerning congenital hearth disease. A prompt diagnosis and surgical intervention can save the child's life. Because of many other symptoms, many diagnostic procedures focused on this syndrome are to be performed, followed by long lasting stimulative treatment and treatment of seizures and psychiatric disorders.

[Internet addiction--a case report].

Some addictions cannot be connected with substance abuse (pathological gambling, video games playing, binge eating, compulsive physical activity, emotional relationship addiction, TV addiction). Since 1995, Internet addiction has been accepted as a clinical entity with profound negative effect on social, familial, educational and economical personal functioning. The diagnosis of Internet addiction could be established if the person spends more than 38 hours per week on the Internet exempting online professional needs. Basic symptoms are the increased number of hours spent in front of the computer along with the Internet use, development of abstinent syndrome if the Internet access is prohibited, sleep inversion, neglect of basic social requirements and personal hygiene, many somatic symptoms developed due to prolonged sitting or monitor watching, dissocial behaviour. In this paper, data about the Internet addiction are presented and a case report of an adolescent with developed Internet addiction.

[Morphological and laminar distribution of cholecystokinin-immunoreactive neurons in cortex of human inferior parietal lobe and their clinical significance].

INTRODUCTION: Cholecystocinine is a neuropeptide whose function in the cortex has not yet been clarified, although its relation with some psychic disorders has been noticed. Previous studies have not provided detailed data about types, or arrangement of neurons that contain those neuropeptide in the cortex of human inferior parietal lobe. The aim of this study was to examine precisely the morphology and typography of neurons containing cholecytocinine in the human cortex of inferior parietal lobule. MATERIAL AND METHODS: There were five human brains on which we did the immunocystochemical research of the shape and laminar distribution of cholecystocinine immunoreactive neurons on serial sections of supramarginal gyrus and angular gyrus. The morphological analysis of cholecystocinine-immunoreactive neurons was done on frozen sections using avidin-biotin technique, by antibody to cholecystocinine diluted in the proportion 1:6000 using diamine-benzedine. RESULTS: Cholecystocinine immunoreactive neurons were found in the first three layers of the cortex of inferior parietal lobule, and their densest concentration was in the 2nd and 3rd layer. The following types of neurons were found: bipolar neurons, then its fusiform subtype, Cajal-Retzius neurons (in the 1st layer), reverse pyramidal (triangular) and unipolar neurons. The diameters of some types of neurons were from 15 to 35 microm, and the diameters of dendritic arborization were from 85-207 microm. A special emphasis is put on the finding of Cajal-Retzius neurons that are immunoreactive to cholecystocinine, which demands further research. CONCLUSION: Bearing in mind numerous clinical studies pointing out the role of cholecystokinine in the pathogenesis of schizophrenia, the presence of a great number of cholecystokinine immunoreactive neurons in the cortex of inferior parietal lobule suggests their role in the pathogenesis of schizophrenia.

[Psychosomatic concept of hyperthyroidism-Graves type--behavioral and biochemical characteristics].

INTRODUCTION: In this study we test the hypothesis that specific behavioral and biochemical vulnerabilities characterize individuals with hyperthyroidism-Graves type, one of the classically cited "psychosomatic disorders". MATERIAL AND METHODS: The sample included 24 subjects with Graves disease and 34 controls. All participants were evaluated for personality and temperament characteristics and for platelet MAO activity. A smaller group of panic disorder patients was tested with the same set of measures to ensure a validity of the study, especially regarding results on personality tests. RESULTS: Individuals with hyperthyroidism had lower platelet MAO activity and higher scores on histrionic (Hy), depressive (D) and hypochondriac (H) subscale on the MMPI-201 than normal controls. Their TPQ temperament scores were characterized by high Harm Avoidance, whereas other temperament traits were average. Platelet MAO activity was inversely correlated with the MMPI-201 psychopatic deviance scale (Pd) and positively correlated with the TPQ Reward Dependence scale. CONCLUSIONS: Our results provide support for the psychosomatic concept of Graves' disease. Personality features, temperament traits, and platelet MAO activity of hyperthyroid individuals are different from those in normal controls and correspond to those observed in anxiety disorders. We propose that the observed behavioral and biochemical similaritites between hyperthyroid and anxiety disorder patients represent an equicausality phenomenon, where the same underlying heritable factors, such as variable central monoaminergic activity coupled with temperament-related susceptibility to stress, facilitate phenotypic manifestation of a number of psychosomatic and psychialric disorders--including Graves disease. The observed correlations between personality traits and MAO activity provide support for the hypothesized functional relationship between the underlying central monoaminergic activity and temperament traits associated with anxiety, depression, and impulsivity.

[Attitudes of psychiatry residents toward mental illness].

INTRODUCTION: Attitudes of lay people and physicians towards mentally ill patients are frequently highly biased. The aim of this study was to investigate differences in attitudes of psychiatry and internal medicine residents toward mental illness and to establish the relationship between their attitudes and their personal characteristics. MATERIAL AND METHODS: The sample consisted of 45 psychiatry and 36 internal medicine residents. The attitudes toward mental illness were assessed using Opinions about Mental Illness Questionnaire (OMI) and personality traits were examined using the Eysenck Personality Questionnaire (EPQ). RESULTS: Our findings showed that in regard to internal medicine residents, psychiatry residents do not consider mentally ill patients to be inferior and dangerous. Psychiatry residents have a benevolent attitude toward the mentally ill. Personality traits of psychiatry residents were not related to their opinions about mental illness. DISCUSSION: The results suggest that there is a need to develop strategies that would bring about changes in the curriculum of training programs for medical residents, including proper training in mental health issues. Such strategies should help in destigmatization of persons with mental disorders and increase the competence of physicians to deal with mentally ill.

[Treatment of neglected and abused children and their families in the context of complicated divorce].

INTRODUCTION: Coceptualisation of complicated divorce, as an escalation of systemic dysfunctioning in a highly disturbed and unbalanced system, acquires attributes of trauma-organised-system, and yields itself for therapeutic interventions. COMPLICATED DIVORCE ISSUES: The authors comment on their experience while treating families sent by Court order in divorce custody disputes, with explicit aim of evaluating parental competence. This type of systemic dysfunction is severely affecting communication styles, family rules and norms, whereas parenting is frequently marked by tendency to repeat relational-style experienced in marital, partners' conflicts. Feelings of discontent and resentment are projected onto children, and may take form of disqualifications, rejection, discrimination or else, those feelings stemming out of personal ambition such as favoring children. Parental rivalry worsens these processes, leading to attempts of establishing inappropriate level of control over children (instrumentalisation or favorisation). Therefore, care and protection of children is inadequate and children are emotionally neglected DISCUSSION AND CONCLUSION: Many of these highly disturbed families, especially those sent by Court order are engaged in a network of different social, legal and mental health institutions. Intervention plans are thus conceived and specifically tailored to suit individual families, confronting dysfunctional patterns and appealing to enhance parental responsibilities. Overcoming family crisis of complicated divorce where childresn's emotional needs are neglected is highly indicated for systemic intervening. The authors discuss their experience in treating such families and offer their questions, dilemmas and recommendations.

[Marital dysfunction and personality characteristics of partners].

INTRODUCTION: A number of studies indicate that an early trauma is of extreme importance (most often experienced in the family of origin) in developing personality disorders. Researches on correlations between family dysfunction and individual psychopathology have been rare and controversial. The reason for this stems from an attempt to establish links between traditional medical models and systemic family therapy. The aim of this research was to explore specific personality structures of married couples and the way they relate to the type of dysfunction within the partner relationship. MATERIAL AND METHODS: The sample consisted of 25 families in the middle of divorce. The examinees were aged 25-45. Specific interactional behavioral patterns were examined by Dyadic Adjustment Scale (DAS), while personality profile data were obtained using Millon Clinical Multiaxial Inventory (MCMI). RESULTS AND CONCLUSIONS: In both groups dependency and obsessivness were marked, while males also presented with marked narcissism. Related to structural personality disorders, we have found only a group of men with significantly increased paranoid dimension. Concerning clinical syndromes, the obtained results revealed anxiety and depressive disorder in both genders and a tendency towards alcohol abuse among men. Results indicated to correlation of communication-interactive family patterns on one hand, and certain personality traits on the other.

[About the professional and ethical profile of an extraordinary physician, humanist and pedagogue, Professor Niko Miljanic]. / O strucnom i etickom profilu licnosti izuzetnog lekara, humaniste i pedagoga, profesora dr Nika Miljanica.

Dr. Niko Miljanic anatomist and surgeon, ordinary professor of the Medical Faculty in Belgrade, had been managing there the anatomy teaching during the period 1920-1934, then held lectures on surgery propedeutics since 1935 till 1947, when being a principled person with the moral sense for the profession and his task as an university professor, after his action as a member of the committee for Election of the Medical Faculty Teachers, he was relieved in 1954 year from the faculty. Professor Miljanic was the author of our first textbooks of anatomy, a monography on asepsis as well as a lot of scientific articles on anatomy and surgery in different journals at home and abroad. As a French ex-pupil he was elected president of the French ex-pupils Association and the founder of the bilingual Serbian-French journal "Anali medicine i hirurgije" (Annals of Medicine and Surgery"), published 1927-1934. In 1930, together with the King Alexander I, he uncover in Belgrade Kalemegdan Park the Monument of the Gratitude to France. He fought in both Balcanic and both World wars. Professor Miljanic was a member of the French Academy of Surgeons and was decorated with the order of the Legion of Honour.

[Effects of ginkgo biloba extract on an experimental model of epilepsy]. / Uticaj ekstrakta gingko bilobe na eksperimentalni model epilepsije.

INTRODUCTION: The active ingredients of ginkgo biloba extracts were determined by biochemical analyses in the last ten years and they are widely used in classical medicine. The active substances of ginkgo biloba extract, mostly affect muscarinic receptors and adrenergic receptors to a lesser degree. Recently, potential effects of ginkgo biloba on NMDA receptors and on epileptogenic seizures have been considered. The main goal of this research was to investigate effects of ginkgo biloba extracts on the experimantal model of epilepsy. MATERIAL AND METHODS: The research was carried out on chinchilla rabbits. GINGIUM solution was used with 40 mg in 1 ml of dry extract of ginkgo biloba leaves. The epileptogenic area was formed by stimulating hippocampus. Bioelectrical activity was registered 60 minutes before the epileptogenic area was formed as well as 90 minutes later. Ginkgo biloba extract was given via i.m, in a single daily dose of 1 ml/kg/BW. RESULTS: A statistically significantly higher frequency of paroxysmal seizures was established after usage of ginkgo biloba. CONCLUSION: According to the results obtained in this research, we can conclude that ginkgo biloba extracts have a proconvulsive activity.