The mediating role of depressive, anxiety, and physical symptoms on work ability index in employed women with breast cancer: a prospective study from Croatia.

AIM: To explore the relationship between the current work ability index (WAI) and depressive and anxiety symptoms in breast cancer (BC) patients and the role of depressive, anxiety, and physical symptoms in mediating this relationship. METHODS: This prospective study enrolled 83 employed women with BC. At baseline assessment (in the first three months following BC diagnosis) and follow-up assessment (one year after baseline), participants completed the WAI, Beck Depression Inventory-II, State-Trait Anxiety Inventory, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire with a breast cancer-specific module. Mediation analyses were conducted to explore the mechanism by which depressive, anxiety, and physical symptoms influenced the relationship between WAI and depressive and anxiety symptoms. RESULTS: WAI was negatively associated with depressive and anxiety symptoms. The effect of baseline depressive and trait anxiety symptoms on WAI at follow-up was mediated by both depressive and trait anxiety symptoms, as well as by physical symptoms at follow-up. The effect of baseline state anxiety symptoms on WAI at follow-up was mediated only by state anxiety symptoms at follow-up. CONCLUSIONS: Baseline depressive and anxiety symptoms affect WAI at follow-up not only through persisting depressive and anxiety symptoms observed at follow-up but also through physical symptoms at follow-up. This indicates that efforts aimed at improving psychological health may result in simultaneous improvements in both psychological and physical health, as well as the resulting WAI.

Depression and stress levels in patients with different psychiatric disorders during concurrent early-phase COVID-19 pandemic and earthquake in Croatia.

BACKGROUND: While Croatia shared COVID-19 pandemic with other countries, its capital area was also hit by a 5.6 magnitude earthquake. The simultaneous impact of these two disasters on psychiatric patients is largely unknown, and we addressed those knowledge gaps. METHODS: The cross-sectional study was conducted during the pandemic's first peak, in the aftermath of earthquake, by telephonic survey. Measurements included the Patient Health Questionnaire-9, the Perceived Stress Scale and the semi-structured interview to evaluate the impact of pandemic stress and earthquake. Overall 396 patients with depression and/or anxiety disorders (DAD), 229 participants with schizophrenia spectrum disorders (SSD) and 205 healthy controls were enrolled. RESULTS: Both patient groups had higher depression and stress levels than controls, independent of sex, age and the presence of somatic comorbidity. After controlling for the same covariates, patient groups had higher COVID-19- and earthquake-related fears than controls. In patients with DAD, both fears were greater than among SSD patients. When comparing the two fears, the fear from earthquake was higher in DAD and control groups, whereas in SSD patients there was no such difference. CONCLUSIONS: Patients with DAD were the most vulnerable group during disasters, while earthquake seems to be associated with more fear than the pandemics, at least in DAD patients and healthy individuals. Future longitudinal studies should determine if early psychological support might alleviate stress levels after disasters and prevent further worsening of mental health, particularly among DAD patients.

SUICIDE ATTEMPTS ARE ASSOCIATED WITH PERSONALITY DIMENSIONS IN CROATIAN WAR VETERANS WITH POSTTRAUMATIC STRESS DISORDER.

BACKGROUND: Patients with combat-related posttraumatic stress disorder (PTSD) have an increased frequency of suicide ideations, but also a higher risk of suicide attempts. Of all the known predisposing risk factors of suicide attempts in this population, personality dimensions are one of the least investigated. The main aim of this study was to examine if personality traits, namely temperament and character dimensions and trait impulsivity, are associated with suicide attempts in war veterans with PTSD. SUBJECTS AND METHODS: his sample included 178 Croatian male war veterans (mean age 49.20 years) treated for PTSD at the Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb. These patients were assessed with the M.I.N.I. diagnostic interview and they filled out several self-report scales: the Beck Depression Inventory-Second Edition (BDI-II), the Temperament and Character Inventory-Revised (TCI-R), the Barratt Impulsiveness Scale-11 (BIS-11), and the Satisfaction with Life Scale (SWLS). RESULTS: It was found that 42 (24%) Croatian war veterans with PTSD had a previous suicide attempt. Comparison between the two groups (participants with vs. those without history of suicide attempts) revealed that patients with previous suicide attempts are less educated and more often unemployed, have a longer duration of psychiatric treatment and more psychiatric hospitalizations, and exhibit higher levels of depression and lower life satisfaction. In multivariate logistic regression analyses, temperament dimension Harm Avoidance and character dimension Self-transcendence were unique predictors of suicide attempts, above the influence of age, education level and length of treatment. CONCLUSIONS: Croatian war veterans with PTSD have a substantial risk of suicide attempts. In addition to the role of some sociodemographic and clinical factors, it seems that certain personality dimensions are uniquely associated with suicide behaviours among these individuals.

Personality Organization and Depressive Symptoms Among Psychiatric Outpatients: The Mediating Role of Shame.

ABSTRACT: Previous research has demonstrated relations between lower level of personality organization (PO) and multiple indices of mental health disturbances. The goal of this research was to examine whether experience of shame would mediate the relationship between PO and depressive symptoms in a sample of 321 Croatian psychiatric outpatients (64% female; mean age, 38.67 years). The total PO level exhibited positive associations with depressive symptoms and with all three subscales of shame ( p < 0.01). Characterological, behavioral, and bodily shame showed significant mediating effects in the PO-depression relationship, while controlling for the influence of age and sex. PO level seems to be strongly related to depressive disturbances, with the experience of shame representing one of the underlying mechanisms of this relationship. Given that patients with personality disorders ( i.e. , low PO level) suffer from poorer treatment outcomes for major mental disorders, more emphasis should be placed on psychotherapeutic management of shame-proneness.

Psychodynamic Aspects of Love: A Narrative Review.

Love is a delicate experience that delves into the foundations of the psyche, and many sources of the emotional experience of love remain unconscious. The nature of love is twofold and contradictory, regressive and progressive, constructive and destructive, connecting and separating, directed toward the object and the self. The ability to idealize is a precondition for "falling in love". Abrupt disappointments can be traumatizing, but gradual ones include the work of mourning and may lead to a more authentic relationship that is less obscured by narcissistic needs. Some aspects of projective identification, which can be a defense, a primitive form of object relation, and a path for psychological change, may be present in all forms of love. These are the close interaction of self and object, blurred boundaries between them, the need that the other person feels what one feels, and a strong desire to continue the relationship. A therapeutic setting can enable the long-term transformation of love in transference and more mature expressions of love in life. The maturation of narcissism is the hallmark of mature love. One of the prerequisites for mature love is a mature superego, which does not require suffering as a prerequisite for satisfying one's needs. Clear differentiation of the boundaries of the self enables safe (temporary) blurring or disappearing of its boundaries and satisfaction of needs for repetition of lost fusion with the primary object of love. Mature love also means the capacity for tolerating ambivalence, i.e., the capacity to integrate both love and hatred experiences of the same person. One can see love as a "glue" that helps integrate different aspects of the psyche into a harmonious whole.

Utility of Screening Questionnaires to Detect Obstructive Sleep Apnea in Patients with Obesity.

BACKGROUND: Obesity is one of today's most concerning health problems due to increased cardiovascular risk, which is still the leading cause of death. Obstructive sleep apnea syndrome (OSAS) is certainly one of the important risk factors that links obesity and cardiovascular risk. There is a great need to evaluate obstructive sleep apnea (OSA) in obese patients. Today, there are easily available and applicable questionnaires (Epworth Sleepiness Scale (ESS), STOP, STOP-Bang (SBQ), Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI)) that could be very useful in clinical practice for this very purpose. The aim of this paper is to investigate the sensitivity and specificity of the questionnaires for OSA screening in obese patients with and without OSA. PATIENTS AND METHODS: This cross-sectional study was carried out in the tertiary healthcare centre. The following questionnaires were used: ESS, STOP, SBQ, ISI, PSQI. 70 (58 female) adult patients with obesity (body mass index (BMI) > 30 kg/m2) were included. RESULTS: SBQ showed sensitivity of 75%, specificity of 75% at cut-off of 5.5 with the Youden index of 0.5, while PSQI had sensitivity of 78%, specificity of 67% at cut-off of 17.75 with slightly smaller Youden index 0.45. STOP and ESS had a sensitivity of 77% and 75%, respectively but with an even smaller Youden index (0.23 and 0.21), and ISI had the lowest sensitivity of 59% and the lowest Youden index (0.13) of the questionnaires we examined. CONCLUSION: Our study results suggest that SBQ and PSQI are best screening tools in detecting OSA in patients with obesity. Further study of these questionnaires and possible modifications are certainly important for future research.

Analysis of Influencer Marketing in the Positioning Healthy Eating According to Generation Z in Croatia.

BACKGROUND: The eating habits of Generation Z have changed a lot compared to other Generations. It is presumed that influencers significantly influence the choice of diet among Generation Z. This study aimed to investigate Generation Z's opinion about social networks and the influence of communication channels, mostly influencers, on the choice of diet. SUBJECTS AND METHODS: This study included 178 participants born between 1997-2010. It was conducted using the Google forms questionnaire program. Participants were initially asked demographic questions such as age, gender, and physical activity. These were followed by questions about their eating habits, social networks, and influencers. After the survey, the results were analyzed using TIBCO Statistica™ 14.0.0. RESULTS: Out of 178 participants, 59% were female, and 41% were male. Most respondents (60.6%) declared that they eat healthily, and among several options to choose from, most respondents chose options related to a healthy diet. Respondents who care about healthy food often seek information from influencers on social networks. Respondents who declared that they eat healthy most often believe that influencers are a credible source of information (p=0.019) and follow influencers for motivation (p=0.022) and for the information they share (p=0.009). Respondents who declared that they pay attention to calorie intake more often believe that influencers are a credible source of information (p=0.011). CONCLUSION: The results of this study suggest that influencers greatly influence the eating habits of Generation Z and that they are aware of healthy eating habits. Also, those who take care of healthy eating, follow influencers.

Anxiety and Treatment Adherence among Glaucoma Patients during COVID-19 Pandemic and Earthquakes in Croatia.

BACKGROUND: The COVID-19 epidemic and earthquakes in Croatia during 2020 suddenly disrupted everyday life and caused psychological disturbances in population. The purpose of the present study was to assess the prevalence of anxiety symptoms and the level of treatment adherence in glaucoma patients during the pandemic. The paper also aimed to evaluate the correlation between anxiety symptoms, treatment adherence and treatment outcomes in the studied cohort. SUBJECTS AND METHODS: This cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at the Department of Ophthalmology, Zagreb University Hospital Center, during one year. The Beck Anxiety Inventory (BAI) was used to measure the level of anxiety symptoms. Treatment adherence was estimated by the Culig adherence scale (CAS). Glaucoma damage was determined for each patient from the level of structural and functional impairment of the worse eye, by retinal nerve fiber layer (RNFL) thickness and mean defect (MD), respectively. Statistical analyses were performed, with a P value of less than 0.05 considered being statistically significant. RESULTS: This study included 113 POAG patients, with a mean age of 65.89 years. The median of the BAI total score in all patients was 10. According to the CAS, 60.2% of patients were non-adherent to glaucoma treatment during the COVID-19 outbreak. The BAI total score was significantly negatively related to adherence to local glaucoma treatment (p<0.001). A significant negative association was also observed between adherence and MD (p=0.017), while no correlation was found between adherence and RNFL thickness (p=0.228). CONCLUSION: Considerable proportion of patients with glaucoma have shown non-adherence to treatment during the COVID-19 pandemic. Anxiety severity was associated with lower adherence, thus indirectly influencing therapeutics outcomes. Special consideration should be given to the strategies promoting mental health and interventions focusing on treatment adherence in glaucoma patients in a time of emergencies.

Shame and COVID-19 Pandemic.

Optimal psychic response during the COVID-19 pandemic is the result of many different factors. One of the main factors is the psychodynamic understanding of essential emotions such as shame. Despite the immense effort by health workers to address stress- and trauma-related disorders in the course of the COVID-19 pandemic, a large proportion of the people affected by the disorder do not have information regarding the emotion of shame. Lack of mentalizing capacity implies disturbed shame dynamics. The therapeutic relationship and optimal alliance offer the frame for acceptance of shame as useful for psychological growth. Empathy should be a cure for dysfunctional shame, at the individual or social level. We believe that including a psychodynamic approach in the national public and mental health emergency system will empower national prevention strategies.

The Impact of Hypoglycemia and EPA and DHA Supplementation on Brain-Derived Neurotrophic Factor Level in Pregnant Women with Type 1 Diabetes: A Prospective Cohort Study.

BACKGROUND: In addition to its neuroprotective effect, Brain-derived neurotrophic factor (BDNF) also plays a role in glucose and lipid metabolism. This study aims: a) to find changes in the BDNF concentration during pregnancy in type 1 diabetes. b) to prove the effect of DHA and EPA supplementation on changes in BDNF concentrations c) to investigate the impact of hypoglycemia on BDNF concentration. SUBJECTS AND METHODS: The data from this study were from the PRE-HYPO cohort study. Twenty-one of them were on a standard diabetic diet enriched with EPA and DHA (EPA 120 mg/day and DHA 616 mg/day; Exposed group), and nineteen pregnant diabetic women were on the standard diabetic diet without EPA and DHA supplementation (Non-exposed group). In the first trimester of pregnancy, fifteen pregnant women developed hypoglycemia episodes (≤3.9 mmol/L; HYPO+ group), and twenty-five pregnant women did not have hypoglycemia episodes (HYPO- group). RESULTS: BDNF concentration significantly decreased during pregnancy from the first to the third trimester, in Non-exposed from 25.1 (22.0-30.2) to 22.1 (16.3-28.2), P<0.05, in the Exposed group from 22.1 (19.8-25.9) to 18.1 (14.8-18.9), P<0.01. Pregnant patients with hypoglycemia episodes (HYPO+ subgroup) had significantly higher BDNF in the third trimester of pregnancy [22.5 (20.6-28.4)] when compared with patients who did not develop hypoglycemia [16.3 (14.3-18.8), P<0.001]. In the third trimester of pregnancy, BDNF and n-6 PUFAs were associated with hypoglycemia (OR 1.818 95 % CI 1.079-3.003, P=0.025; OR 1.103 95 % CI 1.001-1.217, P=0.048). Total F.A.s were inversely associated with hypoglycemia (OR 0.969 95% CI 0.939-0.998, P=0.048). CONCLUSION: Pregnant women with hypoglycemia (HYPO+ group) had higher concentrations of BDNF in the first and third trimesters of pregnancy compared to those without hypoglycemia. An increase in body weight during pregnancy leads to a decrease in BDNF concentration.

The Importance of Psychodynamic Approach during COVID-19 Pandemic.

The coronavirus (COVID-19) outbreak was labeled a global pandemic by the WHO in March of 2020. Understanding how crisis influence an individual's reactions to stressful events (and vice versa) is important in order to create meaningful and effective interventions. Our literature search have revealed lack of the papers related to psychodynamic approach to recent crisis. Psychodynamic places a large emphasis on defense mechanisms and unconscious mind, where upsetting feelings, urges, and thoughts that are too painful for us to directly look at are housed. Even though these painful feelings and thoughts are outside of our awareness, they still influence our behavior in many ways. Optimal application of psychodynamic approach offers the frame for acceptance of psychological stress in a more positive way and benefits psychological growth. We believe that including psychodynamic approach in the national public and mental health emergency system will empower Croatia and the world during (and after) COVID-19 pandemic crisis.

Pathological Narcissism, Negative Parenting Styles and Interpersonal Forgiveness among Psychiatric Outpatients.

BACKGROUND: Pathological narcissism has previously been investigated with regard to negative parenting and interpersonal forgiveness, but inconsistent findings have been obtained in relation to its two phenotypic forms - grandiosity and vulnerability. Moreover, the role of negative parenting in the lack of forgiveness within narcissistic pathology has not been explored thus far. The aim of the current research was to investigate the complex relations among pathological narcissism, negative parenting, and interpersonal forgiveness in psychiatric outpatients. SUBJECTS AND METHODS: A sample of 250 adult psychiatric outpatients (61% female; mean age 39.15 years) were enrolled in this study. The participants filled out the Pathological Narcissism Inventory (PNI), the Tendency to Forgive Scale (TTF), the Measure of Parental Styles (MOPS), and the Depression, Anxiety, Stress Scales (DASS21). RESULTS: Narcissistic grandiosity and narcissistic vulnerability were positively correlated with mothers' and fathers' negative parenting, but this association was significantly stronger in the case of narcissistic vulnerability. Only narcissistic vulnerability was related to interpersonal forgiveness. In the mediation analysis, negative parenting was not directly related to interpersonal forgiveness, however, this association became significant after introducing narcissistic vulnerability. Narcissistic vulnerability served as a full mediator of the mothers' and fathers' negative parenting - interpersonal forgiveness relationships. CONCLUSIONS: Narcissistic vulnerability seems to be more strongly related to negative parenting and interpersonal forgiveness than narcissistic grandiosity, while it also represents one of the underlying mechanisms of the negative parenting - interpersonal forgiveness relationship. The clinical implications of these findings are discussed in relation to pathological narcissism and lack of forgiveness.

Nicotine dependence in Croatian male inpatients with schizophrenia.

BACKGROUND: Patients with schizophrenia have the highest known rates of cigarette smoking, but less is known about their smoking behavior and the differences across geographical regions, including Croatia. The aim of this study was to compare patterns of nicotine dependence between patients with schizophrenia and healthy individuals, and to determine the relationship between clinical presentation and the severity of smoking. METHODS: This cross-sectional study included 182 recently hospitalized male inpatients and 280 healthy males, who were daily smokers. All participants have fulfilled the Fagerstrom Test for Nicotine Dependence (FTND). Patients were also evaluated by the Positive and Negative Syndrome Scale (PANSS). RESULTS: Patients had higher FTND total score (p = 0.010), smoked their first cigarette earlier in the morning (p = 0.000), consumed higher number of cigarettes (p = 0.000), while healthy subjects had more difficulties to refrain from smoking in places where it is forbidden (p = 0.000) and smoked more even when they were sick (p = 0.000). While severe dependence was more prevalent in the patient group, light dependence was more frequent in control subjects (p = 0.04). Smoking behavior was not associated with either PANSS total score or any of its subscales and items. CONCLUSIONS: Smokers with schizophrenia differ from healthy smokers in both smoking behavior and level of dependence. Longitudinal studies are needed to shed more light on the complex relationship between smoking and psychopathology in schizophrenia.

The role of psychodynamic and personality assessment in psychopharmacotherapy of suicidal psychotic patients.

Optimal psychopharmacotherapy is based upon the results of many different factors. One of the main factors is therapeutic alliance. The role of psychodynamic is very important in the context of good therapeutic alliance. Lack of mentalizing capacity implies disturbed view of psychopharmacotherapy. Therapeutic relationship and optimal alliance offers the frame for acceptance of psychiatric drugs as positive and useful for psychological growth. Our literature search of a recent papers relating psychopharmacology and psychodynamic have revealed progress in psychoanalytic theory related to medication.

Experience of Shame Mediates the Relationship Between Pathological Narcissism and Suicidal Ideation in Psychiatric Outpatients.

OBJECTIVE: Pathological narcissism, described by 2 dysfunctional phenotypic forms-grandiosity and vulnerability-has often been connected to suicidal tendencies in theoretical and clinical literatures. Furthermore, shame proneness has been implicated as a key mechanism that links these 2 constructs. However, empirical evidence for the presumed relationship between pathological narcissism and suicidal tendencies is sparse, and no prior research has investigated the role of shame proneness in this relationship. The objective of the present research was to investigate the complex relations among pathological narcissism, experience of shame, and suicidal ideation in psychiatric outpatients. METHOD: A sample of 250 adult psychiatric outpatients (61% female; mean age 39.15 years) were assessed between January and May 2014. The participants filled out the Pathological Narcissism Inventory, the Experience of Shame Scale, and the Suicide Assessment Scale-self-rating. RESULTS: Narcissistic vulnerability was found to have unique positive associations with acute suicidal ideation, whereas narcissistic grandiosity exhibited substantially weaker relations with the same construct. Two dimensions of shame-characterological and bodily shame-mediated the relationship between narcissistic vulnerability and suicidal ideation. The mediating role of behavioral shame was not demonstrated. CONCLUSIONS: Narcissistic vulnerability seems to be more strongly related to suicidal tendencies than narcissistic grandiosity, while experience of shame represents one of the underlying mechanisms of this relationship among psychiatric outpatients. The implications of these findings are discussed in relation to the role of pathological narcissism in the psychotherapeutic management of suicidality.

Comorbid Depression and Suicide Ideation in Patients with Combat-Related PTSD: The Role of Temperament, Character, and Trait Impulsivity.

BACKGROUND: War veterans with PTSD have a high chance of developing major depressive disorder (MDD) at some point, while they can also exhibit increased suicidal tendencies. The primary goal of this research was to investigate whether personality dimensions, including temperament, character, and trait impulsivity, were associated with comorbid MDD, as well as with suicidal ideation in psychiatric patients suffering from combat-related PTSD. SUBJECTS AND METHODS: The sample consisted of 148 Croatian male war veterans (mean age 49.53 years) treated for PTSD at the National Center for Psychotrauma, Department of Psychiatry, University Hospital Center Zagreb. Fifty-one (34%) of them met ICD-10 diagnostic criteria for current or lifetime MDD, while 97 (66%) were diagnosed with PTSD alone. All the participants were assessed with the M.I.N.I. diagnostic interview and they completed the following battery of self-report instruments: the Beck Depression Inventory-Second Edition (BDI-II), the Suicidal Behaviors Questionnaire-Revised (SBQ-R), the Temperament and Character Inventory-Revised (TCI-R), and the Barratt Impulsiveness Scale-11 (BIS-11). RESULTS: Comparisons between the two clinical groups showed that PTSD+MDD patients were more suicidal and differed with regard to temperament dimensions Harm Avoidance, Reward Dependence and Persistence, character dimension Self-Directedness, and trait impulsivity. In three multivariate regression analyses, it was revealed that character dimension Cooperativeness as well as trait impulsivity were unique predictors of suicidal ideation, while controlling for the influence of sociodemographics, length of treatment and comorbid depression. CONCLUSIONS: Combat-related PTSD patients with comorbid depression exhibit increased suicide thoughts and different personality profiles in comparison with those suffering from PTSD alone. Character dimension Cooperativeness and trait impulsivity seem to be uniquely predictive of suicide ideation in this population. Elucidation of individual psychological factors that increase the risk of MDD and suicidal tendencies in war veterans with PTSD may facilitate more effective prevention and treatment methods.

Quality of Life and Depression Among Female Patients Undergoing Surgical Treatment for Breast Cancer: A Prospective Study.

BACKGROUND: Breast carcinoma is the most common malignant disease in women in the majority of developed countries. The development of depression as well as the quality of life (QoL) in these patients depends not only on the result of oncologic treatment, but on the cosmetic outcome as well. The primary aim of this prospective study was to investigate the changes in QoL and depressive symptoms among patients undergoing surgical treatment for breast cancer. SUBJECTS AND METHODS: We conducted a prospective study that included 100 female patients (mean age 60.26 years) who underwent surgical and oncological treatment for breast carcinoma at the University Hospital Center Zagreb, Croatia. The patients were photographed before and after treatment and were required to fill out a standardized quality of life questionairres QLQ - C30 and QLQ - BR23, Beck Depression Inventory (BDI) and a questionnaire on breast asymmetry. RESULTS: Our results show that patients had significantly higher QoL levels compared with their pre-surgical results. Statistical trend of a lower degree of depression was also observed. A worse cosmetic outcome (i.e., postoperative assymetry) was associated with a lower QoL, but there was no association with depression. Depression was significantly related to the level of pain and lower financial status. CONCLUSION: QoL improved after surgical treatment of breast cancer and was dependant on postoperative asymmetry, whereas the findings for depressive symptoms remained less clear. Future research should investigate more factors that may contribute to the QoL and degree of depression in this patient population.

Development of a Valid and Reliable Instrument for the Assessment of Quality of Life in Adolescents with Clefts - Detection of Potential Mental Health Issues.

BACKGROUND: The rehabilitation of patients with cleft deformities is very complex and unique, and managed by a team of professionals. Quality of life depends on the health, and represents an instrument that examines the disease impact and treatment modalities on the health, integrating an objective assessment of the health status and its subjective experience. Children with clefts are often teased by their peers, and that is the reason why they experience different kinds of psychological distress. Patients with non-syndromic clefts may develop depression and anxiety, hyperactivity, elevated risk of suicide and increased drug abuse in adolescence. SUBJECTS AND METHODS: Experienced members of a cleft palate team developed a specific questionnaire divided into 2 parts: the first contains the clinical profile of adolescents, and the second part contains questions regarding quality of life. This questionnaire was administered to 73 patients between June 2015 and June 2016, who matched these criteria during their control examinations at the University Hospital Dubrava. RESULTS: In general, the patient group showed significantly worse scores on majority of answers, specifying that their quality of life is worse compared to the control group. The principal component analysis revealed the presence of three components (factors). The interpretation of the three components was consistent with loadings indicating the component names: Component 1: The relationship with parents, success, society; Component 2: Appearance, and Component 3: Function. CONCLUSION: According to our results, we created a specific instrument - The Quality of Life in Adolescents with Cleft Assessment to assess aesthetic and functional results of treatment and quality of life of the operated adolescents with clefts. The adolescents in this study have no psychiatric disorders diagnosed in their medical charts, but results indicate that some of them need help in dealing with future life. Regarding these findings, it will be possible to intervene in the process of treatment and improve the overall outcome of therapy.

Manic Defences in Contemporary Society. The Psychocultural Approach.

The article discusses the impact of contemporary culture on the individual's personality. We used the "psychocultural" approach whose key feature is the amalgamation of theories and methods belonging to psychodynamic and psychosocial studies, as well as those used in the field of media and cultural studies. The idea of a potentially therapeutic effect of culture (therapy culture) can already been seen in Freud's and Lacan's texts, and it is often used in critical analyses of contemporary corporate culture, which is more or less developed in some parts of the world. In their criticisms, many contemporary authors emphasize that modern societies have a tendency towards the weakening of basic commitment, or lack thereof, to a social equivalent of Winnicott's concept of environmental provisions as an inalienable democratic right essential for human emotional and mental progress or emotional well-being. The article describes frequent resorting to the so-called manic defences that defensively distort, deny and obscure the awareness that a human being is not the omnipotent source of life, but instead depends on other human beings, and often tries to compensate for loss through various activities. The article describes excessive shopping as an activity that often serves as an attempt to find what was lost, i.e. to fill an emotional void. This solution (resorting to manic defences) is encouraged by contemporary culture, especially through promotional material (e.g. advertising). The main theses of this article are supported by quotations and data from world literature.