Background: In the ICD-11 hierarchical classification structure, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are separate and distinct but also 'sibling' disorders, meaning that the ...diagnoses follow from the parent category of traumatic stress disorders.
Objective: The aim of this study was to examine the prevalence of CPTSD in treatment-seeking war veterans with PTSD more than 20 years after the exposure to cumulative war-related trauma(s). The second aim was to examine if there was an association between demographic and psychosocial variables and CPTSD or PTSD.
Method: A sample of 160 male war veterans with PTSD referred to the outpatient service of the PTSD Referral Centre at the Clinical Hospital Centre (CHC) Rijeka participated in a cross-sectional study. Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview (MINI) and participants completed validated self-report measures: The Life Events Checklist for DSM-5 (LEC-5), International Trauma Questionnaire (ITQ).
Results: In total, 80.63% of the sample met criteria for a probable diagnosis of CPTSD. The study revealed that there was no significant difference in the length of deployment, in the intensity of the PTSD symptoms, types of trauma exposure and pharmacotherapeutic treatment between PTSD and CPTSD group. It was found that veterans with PTSD were more likely to be divorced and to participate in PTSD clubs. On the other hand, veterans with CPTSD were significantly more likely to have higher levels of functional impairment and comorbidity with general anxiety disorder (GAD) compared to the PTSD group.
Conclusions: This study supports the proposition that a prolonged trauma of severe interpersonal intensity such as war is related to high rates of CPTSD among treatment-seeking veterans, years after the war. The distinction between PTSD and complex PTSD may help the selection of person-centred treatment interventions that would target specific mental health and functional problems in patients.
Abstract Objective Patients with schizophrenia are more likely to be smokers than the general population, which makes them an interesting group with which to study the etiology of nicotine ...dependency. We studied the prevalence of a gene variant of peroxisome proliferator-activated receptor alpha ( PPARα ) in schizophrenia, together with nicotine dependency, to investigate whether the PPARα -L162V polymorphism (rs1800206) influences nicotine dependency in schizophrenia. Given evidence suggesting that smoking influences the severity of schizophrenia, together with our recent data linking the PPARα -L162V polymorphism to clinical manifestations of schizophrenia (in the Croatian population), we hypothesized that interactions between the two (smoking and the PPARα -L162V polymorphism) might contribute to disease onset and scores for the Positive and Negative Syndrome Scale. To the best of our knowledge, this is the first study to investigate the possible associations between the PPARα gene and nicotine dependency. Patients and methods Genotyping was performed for 267 chronically ill schizophrenia patients (males/females: 140/127) by polymerase chain reaction. Results A significant excess of PPARα -L162V genotypes and PPARα -162V alleles were detected among female smokers in comparison to female nonsmokers (18.2% vs . 2.0%, and 9.1% vs . 1.0%, p < 0.01, respectively). We also revealed a significant PPARα genotype-smoking interaction that predicted positive symptom severity among male patients ( F = 4.43, p < 0.05). These data indicated that the PPARα -L162V heterozygous genotype, depending on smoking status, might be of relevance as either protective, or a risk factor, for the severity of positive symptoms. No interaction between the PPARα -L162V polymorphism and smoking for the time of onset of schizophrenia was detected ( p > 0.05, respectively). Conclusion We demonstrated two significant, yet weak effects. The first showed an effect of the PPARα -L162V polymorphism on the risk of nicotine dependency. The second linked the PPARα genotype-smoking interaction to positive symptoms severity among schizophrenia patients; both effects manifested in a gender-specific fashion.
•We investigated the possible associations between PLA2G4A and PLA2G6 gene polymorphisms and nicotine dependence in schizophrenia.•This is the first report on PLA2 genes and nicotine dependence.•We ...observed two significant, though weak, effects of the PLA2G6 polymorphism.•The PLA2G6 polymorphism influences smoking risk in male patients.•The PLA2G6 genotype-smoking interaction influences disease onset in male patients.
We investigated the relationship between the rs10798059 (BanI) and rs4375 polymorphisms in the phospholipase A2 (PLA2)G4A and PLA2G6 genes and the risk of nicotine dependence in 263 Croatian patients with schizophrenia. We also examined whether interactions between these polymorphisms and smoking contributed to schizophrenia onset and Positive and Negative Syndrome Scale (PANSS) psychopathology. We found no significant differences in the distribution of PLA2G4A genotypes and alleles according to smoking status, and no effect of the PLA2G4A genotype-smoking interaction on disease onset or PANSS. The PLA2G6-TT homozygous genotype was significantly overrepresented in male smokers compared to nonsmokers (34.7% vs. 17.1%, p < 0.05). These patients had ∼2.6-fold higher risk of becoming smokers than males with heterozygous PLA2G6-CT and homozygous PLA2G6-CC genotypes. In addition, male smokers without the PLA2G6-C allele (PLA2G6-TT homozygous) experienced earlier onset than nonsmoking homozygous PLA2G6-TT males. Thus, the PLA2G6 polymorphism affected the risk of nicotine dependence in male patients and the PLA2G6 genotype-smoking interaction was linked to the age of disease onset.
We investigated the relationship between the functional insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene and the risk of nicotine dependence in Croatian ...schizophrenia patients. We also tested whether interactions between ACE-I/D polymorphism and smoking status affected the clinical psychopathology findings in patients as measured using Positive and Negative Symptom Scale (PANSS) scores. Polymerase chain reaction analysis was used to genotype 267 chronically ill schizophrenia patients (140 males/127 females). There were no significant differences in the distribution of ACE genotypes and alleles in male or female schizophrenia patients who were stratified based on their smoking status. However, there was a trend toward a difference in the ACE genotype distribution in female smokers vs. nonsmokers (
χ
2
= 5.13,
p
= 0.077) that was due mainly to the significant overrepresentation of ACE-ID heterozygous genotypes in female smokers compared to nonsmokers (62.3 vs. 42.0%,
p
= 0.025). ACE-ID heterozygous females had about a twofold higher smoking risk than ACE-II and ACE-DD homozygous carriers (OR = 2.29, 95% CI 1.1–4.7,
p
= 0.026). We observed no contribution of the ACE genotype-smoking interaction to PANSS psychopathology. This is the first study to investigate the possible association between ACE-I/D polymorphism and nicotine dependence in schizophrenia. Our results suggest that the ACE-I/D polymorphism may be relevant in determining the risk of nicotine dependence in female patients with schizophrenia while the ACE genotype-smoking interaction does not contribute to the clinical expression of schizophrenia.
Depression is an illness of modern society, which affects population of different age. Etiological factors differ, and frustration factors as a cause of depression are multiplying. Each new episode ...presents difficulties, both for patients and psychiatrists. Despite the increasing number of antidepressants we use in treatment, it is sometimes hard to notice an efficient antidepressant in an optimal-efficient dose. In resistant cases we apply combinations of psychopharmacs, and the choice of the same depends on the leading symptoms. We will present the case of a 67-year-old patient where a depressive episode (in the terms of a reccurent major depressive disorder) lasts for one year. During this period she was treated as outpatient and inpatient with several antidepresants in combinations with other psychopharmacotherapeutical drugs. Despite regular treatment, mental state was worsening. Clinical presentation was indicating developing of dementia (behavior, cognition outges), which we excluded through diagnostic process. Psychopharmacological combinations (antidepresants, mood stabilizators, antypschotics, anxsiolotix) were not efficant. Progression of simptoms leads to rehospitalisation. In further treatmen, we followed the principle "Less is more" which resulted with an expected and satisfactory outcome.
Cilj: Istražili smo povezanost pojave pretilosti s kliničkim značajkama shizofrenije, poput dobi, trajanja bolesti, dobi nastupa bolesti, ovisnosti o pušenju i težine simptoma ocjenske ljestvice ...PANSS-a (engl. Positive and Negative Syndrome Scale – PANSS). Također smo testirali doprinos pretilosti biokemijskim parametrima: koncentracijama ukupnog kolesterola, LDL kolesterola (engl. low density lipoprotein cholesterol), HDL kolesterola (engl. high density lipoprotein cholesterol), triglicerida i glukoze u plazmi. Ispitanici i metode: U istraživanju su sudjelovala 142 kronična pacijenta sa shizofrenijom. Pretilim pacijentima smatrani su oni s vrijednostima indeksa tjelesne mase (ITM) > 30, dok su pacijenti s normalnom tjelesnom masom (ITM: 20 – 25) i pacijenti s prekomjernom tjelesnom masom (ITM: 25 – 30) klasificirani u nepretile. Rezultati: Nije uočena statistički značajna povezanost pretilosti s kliničkim značajkama (P > 0,05). Koncentracije ukupnog kolesterola i LDL kolesterola bile su značajno više u pretilih pacijentica u odnosu na nepretile pacijentice, dok su značajno više vrijednosti triglicerida uočene kod pretilih u odnosu na nepretile ispitanike oba spola (P < 0,05). Ipak, samo se trajanje bolesti pokazalo značajnim prediktorom vrijednosti triglicerida u pacijentica, dok je učinak pretilosti ostao izvan statističke značajnosti (P > 0.05). Pojava pretilosti opisuje približno 8,3 % varijabilnosti koncentracija triglicerida u muškaraca te 9,6 % i 13,8 % varijabilnosti koncentracija ukupnog kolesterola i LDL kolesterola u žena. Zaključak: Pretilost pridonosi isključivo biokemijskim parametrima u pacijenata sa shizofrenijom. U muškaraca determinira vrijednosti triglicerida, a u žena koncentracije ukupnog kolesterola i LDL kolesterola te opisuje približno 8,3 – 13,8 % varijabilnosti njihove koncentracije.
Aim: We investigated the association between obesity and clinical characteristics of schizophrenia, such as age, illness duration, age of illness onset, nicotine dependence and clinical psychopathology measured via Positive and Negative Syndrome Scale scores. We also tested whether obesity contributes to biochemical parameters: plasma total cholesterol, LDL cholesterol (low density lipoprotein cholesterol), HDL cholesterol (high density lipoprotein cholesterol), and triglyceride and glucose levels. Patients and methods: Our study group consisted of 142 chronically ill patients with schizophrenia. Patients were classified as obese with body mass index (BMI) values > 30, and non-obese, those who were overweight (BMI: 25 – 30), or those having a normal body weight (BMI: < 25). Results: We did not find statistically significant associations between obesity and clinical characteristics (P > 0.05). Plasma total cholesterol and LDL concentrations were significantly higher in obese females compared to non-obese females, and significantly greater plasma triglyceride values were observed among obese patients of both genders compared to non-obese (P < 0.05). However, only the illness duration significantly predicted triglyceride concentration in females, whereas the influence of obesity on triglyceride levels did not reach significance (P > 0.05). The obesity accounts for approximately 8.3 % variability of triglyceride values in males and 9.6 % and 13.8 % of total cholesterol and LDL cholesterol variability in females. Conclusion: The obesity significantly contributes only to biochemical parameters in patients with schizophrenia. In males, it determines triglyceride values, whereas in females, it underlies total cholesterol and LDL cholesterol levels, accounting for approximately 8.3 – 13.8 % of their variability.
Cilj: Ispitali smo utječu li, i u kojoj mjeri, koncentracije lipida i glukoze u plazmi te vrijednosti indeksa tjelesne mase (engl. body mass index; BMI), na težinu kliničke slike shizofrenije u ...hrvatskih bolesnika, ovisno o njihovom pušačkom statusu.
Ispitanici i metode: U istraživanju je sudjelovalo 263 kroničnih bolesnika (muškarci/žene: 139/124). Težina kliničke slike procijenjena je korištenjem ocjenske ljestvice PANSS-a (engl. Positive and Negative Syndrome Scale) u akutnoj fazi bolesti tijekom posljednje hospitalizacije. U pušače su klasificirani ispitanici koji puše najmanje jednu cigaretu dnevno u periodu duljem od godine dana, a u nepušače oni koji su popušili manje od 100 cigareta tijekom života.
Rezultati: Koncentracije triglicerida, glukoze i vrijednosti BMI-a nisu pokazale povezanost s PANSS psihopatologijom, niti u bolesnika, niti u bolesnica, ovisno o pušačkom statusu (svi P > 0,05), a na težinu kliničke slike u bolesnica, utjecale su isključivo koncentracije kolesterola. Bolesnice pušači s višim koncentracijama LDL kolesterola (engl. low density lipoprotein cholesterol) imale su značajno niže vrijednosti općih i ukupnih simptoma (P = 0,023 i P = 0,015), dok su u bolesnica nepušača s višim koncentracijama HDL kolesterola (engl. high density lipoprotein cholesterol), uočene značajno niže vrijednosti pozitivnih i ukupnih PANSS simptoma (P = 0,041 i P = 0,002). Koncentracija LDL kolesterola opisuje približno 20% varijabilnosti općih simptoma i 23% varijabilnosti ukupnih simptoma u bolesnica pušača, a vrijednosti HDL kolesterola pridonose s otprilike 39% težini pozitivnih simptoma te s 69% težini ukupnih simptoma u bolesnica nepušača.
Zaključak: Na temelju naših rezultata možemo zaključiti da na težinu kliničke slike shizofrenije utječu isključivo koncentracije kolesterola u bolesnica. Nadalje, koncentracije kolesterola opisuju mali do umjereno veliki udio varijabilnosti PANSS psihopatologije.
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