An emergency in psychiatric setting is any disorder in thought process, feelings and/or behavior of the patient that requires urgent therapeutic intervention. In general, we can observe an increase ...in numbers of psychiatric emergencies throughout the world and in Croatia as well. Agitation and aggression are one of the most common causes of emergency in psychiatry. Agitation is common and frequent in patients suffering from schizophrenia. Patient can be agitated in various levels such as: mild, moderate or severe and can alternate between these levels in the same presentation. Agitated patients often require hospitalization that includes pharmacotherapy and sometimes physical restraining, in order to treat the cause of agitation and prevent auto and/or heterodestructive behavior.
In this paper we focus on patients suffering from schizophrenia that were admitted in University Hospital "Vrapče" in 2017, and assess the numbers through the criteria of voluntary vs. involuntary admissions and physical restraint usage.
Out of total observations, 130 (35.6%) were patients admitted for the first time and 179 (49%) were patients later diagnosed with schizophrenia spectrum and other psychotic disorders. Court ordered involuntary hospitalization was ordered for 35 (2.8%) patients out of total admitted patients, and 68.6% (N24) of them were diagnosed with schizophrenia spectrum and other psychotic disorders. Physical restraint was used for 122 patients out of total admissions and 28.7% (N35) of restrained patients were diagnosed with schizophrenia spectrum and other psychotic disorders.
Emergencies in patient suffering from schizophrenia are extremely delicate and demanding situations in every-day clinical practice of psychiatrist. There is an increased risk involved for the patient but for the staff as well. All interventions should be individualized and patient should carefully monitored throughout the entire process. All professionals involved in care for a patient should be up to date with medical and legal issues.
First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early ...interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models.
Granični poremećaj ličnosti je učestali psihički poremećaj koji se manifestira kroz simptome afektivne nestabilnosti, impulzivnog i nekontroliranog ponašanja, poremećaj identiteta, nestabilne ...interpersonalne odnose i moguće pogreške u testiranju realnostiuslijed kojih osoba može imati značajnih poteškoća u osobnom, roditeljskom, obiteljskom, socijalnom i radnom funkcioniranju. U ovom radu prikazani su rezultati kvalitativnog istraživanja »Prepoznavanje simptoma graničnog poremećaja ličnosti roditelja u situacijama ugrožene dobrobiti djeteta« u kojem je sudjelovalo 12 socijalnih radnika i psihologa iz Odjela za zaštitu djece, obitelji i braka centara za socijalnu skrb na području Grada Zagreba i Zagrebačke županije. Istraživanje je provedeno metodom polustrukturiranog intervjua. U obradi podataka korištena je tematska analiza. Rezultati istraživanja pokazuju da stručnjaci u svakodnevnom radu u situacijama ugrožene dobrobiti djeteta prepoznaju različite simptome afektivne nestabilnosti, impulzivnog i nekontroliranog ponašanja, smetnji identiteta, nestabilnih i intenzivnih interpersonalnih odnosa te teškoća testiranja realnosti koje su potencijalno povezane s mogućim graničnim poremećajem ličnosti roditelja. Kao otežavajuću okolnost u radu s ovim roditeljima stručnjaci iz centara za socijalnu skrb navode poteškoće suradnje sa stručnjacima iz zdravstvenog sustava.
Abstract
Background
Cognitive dysfunctions have long been observed in patients with schizophrenia, while cognitive symptoms are receiving a lot of attention due to the fact they can be considered ...core symptoms of schizophrenia. Cerebral blood flow has been by some researchers associated with cognitive functioning, or at least some aspects of cognitive functions. Because of its distinctive psychopharmacologic properties, aripiprazole is deemed a substantially different antipsychotic compared to the majority of the available compounds. It has been hypothesised that due to this fact it could have beneficial effects especially on cognition in schizophrenia. In line with that thought, the objective of this study was to investigate whether use of an atypical antipsychotic aripiprazole has beneficial effects on cerebral blood flow and cognitive functioning in patients with a first episode of schizophrenia during a three month treatment.
Methods
Forty patients were included in the ongoing study. At baseline and at three month follow up schizophrenia symptomatology was assessed by PANSS, cognitive functions by 5-KOG screening instrument for cognition in psychiatry, while cerebral blood flow was assessed by 99mTc-D,L-hexamethylene-propyleneamine oxime (99mTc-HMPAO) using a SPECT technique.
Results
After three months of treatment, we observed a significant improvement of schizophrenia symptoms and cognitive functions, measured by PANSS and 5-KOG, with all of the five subscales of the latter and its total score being significantly higher than at baseline (p<0.05). Similarly, cerebral blood-flow measured by SPECT improved at three months follow up compared to baseline.
Discussion
Use of aripiprazole in first episode patients with schizophrenia is associated with increased fronto-temporal cerebral blood flow and improvement of schizophrenia symptomatology, including cognition indices. Although we cannot confirm it directly, it is possible that improved fronto-temporal cerebral blood flow led to the improvement in cognition indices.
Shizofrenija je kronična duševna bolest, klinički sindrom karakteriziran specifičnim psihičkim i ponašajnim simptomima, značajnim individualnim varijacijama kliničke slike, odgovora na terapiju i ...tijeka bolesti te često prisutnim značajnim padom funkcionalnih kapaciteta bolesnika na svim planovima – osobnom, obiteljskom, radnom i socijalnom.
Suvremeni koncepti sagledavanja shizofrenije kao neurodegenerativnog procesa impliciraju neophodnost razvoja specifičnih ranih intervencija usmjerenih na što raniju detekciju bolesti i provođenje adekvatnih i sveobuhvatnih farmakoloških, psihoterapijskih i psihosocijalnih terapijskih intervencija. Iz navedenog proizlazi i rastući interes struke za prodromalnu fazu bolesti i prvu epizodu shizofrenije pri čemu se naglasak stavlja na ishod bolesti (postizanje simptomatske i funkcionalne remisije i što bolji potpuni oporavak bolesnika).
Ciljevi ranog otkrivanja psihotičnih poremećaja, uključujući i shizofreniju, i ranih intervencija su reducirati i/ili prevenirati progresiju i/ili pogoršanje psihotičnih simptoma/sindroma, neurobioloških i neuropatoloških oštećenja, sekundarnog psihijatrijskog i somatskog morbiditeta, deterioracije općeg funkcioniranja i razvojnih potencijala bolesnika, individualnog i obiteljskog stresnog iskustva, stigmatizacije bolesnika i njegove okoline, recidiva bolesti te reducirati troškove vezane uz liječenje i radnu nesposobnost oboljelog.
Ovo složeno područje zahtijeva kontinuirano stručno i znanstveno multidisciplinarno istraživanje i djelovanje u čemu aktivnosti socijalnih radnika imaju značajnu ulogu, a s ciljem što učinkovitije redukcije neurotoksičnih, psihotoksičnih i sociotoksičnih posljedica shizofrenog procesa.
Granični poremećaj ličnosti najčešće se javlja u kasnoj adolescenciji ili mlađoj odrasloj dobi, a njegova najjasnija prezentacija je u odrasloj dobi, nakon završetka psihološkog sazrijevanja. ...Simptomi ovog poremećaja manifestiraju se nestabilnim afektom, impulzivnim ponašanjem, poremećajem identiteta, nestabilnim interpersonalnim odnosima i mogućim pogreškama u testiranju realnosti što sve može rezultirati značajnim poteškoćama osobnog, obiteljskog, roditeljskog, socijalnog i radnog funkcioniranja. Prognostički dodatnu otegotnu okolnost predstavljaju i česti komorbiditeti (afektivni poremećaji, anksioznost i zlouporaba sredstava ovisnosti itd). Etiološki čimbenici poremećaja su mnogobrojni i nedovoljno poznati, a na razini današnjih saznanja uključuju interakciju bioloških predispozicija i okolišnih faktora. U liječenju i skrbi za osobe s graničnim poremećajem ličnosti, uz psihoterapiju i socioterapiju (i po potrebi farmakoterapiju), neophodna je i primjena sveobuhvatnih psihosocijalnih intervencija pri čemu ključnu ulogu imaju socijalni radnici. Pravodobno prepoznavanje etioloških čimbenika i poduzimanje mjera iz nadležnosti socijalnih radnika u okviru sustava socijalne skrbi može pridonijeti prevenciji javljanja ovog poremećaja ličnosti, dok mjere i intervencije koje se primjenjuju prema oboljelim osobama mogu pomoći u njihovoj rehabilitaciji i dobrobiti, kao i dobrobiti članova njihove obitelji.
Abstract
Background
Dopamine and serotonin neurotransmission relies mostly on the action of four factors: serotonin and dopamine transporters (SERT and DAT) and enzymes monoaminooxidase A (MAO-A) and ...catechol-O-mehtyltransferase (COMT). The goal of this research was to closely examine schizophrenia symptom domains in relation to the investigated polymorphisms.
Methods
Study group was composed of 300 schizophrenic patients. Severity of schizophrenia was assessed by the Positive and negative syndrome scale (PANSS), depressive symptoms were assessed with Calgary depression scale for schizophrenia (CDSS). SERT (5-HTTLPR), DAT (VNTR), COMT (Val158Met) and MAO-A (VNTR) gene polymorphisms were analyzed. Schizophrenia symptom dimensions were determined with multivariate statistical methods, while logistic regression and ANOVA were used to investigate the influence of a genotype on a symptom domain.
Results
Factor analysis of PANSS scale retained all 30 items and identified 5 separate factors (aggressive/impulsive, affective/depressive, cognitive, negative and positive symptoms). Analysis of CDSS scale revealed 2 separate factors (depression and suicidality).
Statistically significant PANSS variables were those of aggressive/impulsive and negative symptoms, while suicidality was the only significant CDSS variable.
Discussion
Our PANSS scale factor analysis established 5 distinct factors. Previous factor analyses provided from 3, up to 7 different factors, but mostly 5 distinct ones: negative symptoms, positive symptoms, depressive symptoms, excitement and disorganization. That factor distribution corresponds to our findings in terms of identified number of factors, but seems to differ in terms of item distribution within those factors.
When testing the influence of investigated gene polymorphisms on the variable of total PANSS score and five distinct factors we did not establish significant findings regarding four variables: total PANSS score, positive, cognitive and affective/depressive symptoms. While that is in line with majority of other investigations, SERT promoter polymorphism and COMT Val158Met gene polymorphism have been previously associated with depressive and positive symptoms. SERT and MAO-A polymorphisms separately had a significant effect on the variable of aggressive/impulsive symptoms, which has not been reported earlier. Furthermore, significant influence of COMT gene polymorphism was established for the variable of negative symptoms, which is a confirmation of some earlier reports, although there have been contrary findings.
Previous reports of CDSS scale factor structure are limited to data from its initial validation to the few recent findings of its three-factor structure (depression, cognition and melancholy). We identified 2 separate factors using factor analysis, “depression” (which included seven out of nine items) and “suicidality”. To the best of our knowledge this is the first investigation of the putative association between any of the four investigated polymorphisms and depressive symptoms of schizophrenia measured by the CDSS scale. Ultimately, we did not establish a significant association of investigated gene polymorphisms and total CDSS score, as well as the “depression” factor. However, there was a significant association between the “suicidality” factor and SERT and MAO-A gene polymorphisms, as well as their interaction. The fact that the significant association was established for only one of the two obtained CDSS factors suggests that the association is subtle and, at least partially, explains rarely reported associations between investigated gene polymorphisms and schizophrenia symptom domains, which is especially true for depressive symptomatology.
Granični poremećaj ličnosti je učestali psihički poremećaj koji se manifestira kroz simptome afektivne nestabilnosti, impulzivnog i nekontroliranog ponašanja, poremećaj identiteta, nestabilne ...interpersonalne odnose i moguće pogreške u testiranju realnostiuslijed kojih osoba može imati značajnih poteškoća u osobnom, roditeljskom, obiteljskom, socijalnom i radnom funkcioniranju. U ovom radu prikazani su rezultati kvalitativnog istraživanja »Prepoznavanje simptoma graničnog poremećaja ličnosti roditelja u situacijama ugrožene dobrobiti djeteta« u kojem je sudjelovalo 12 socijalnih radnika i psihologa iz Odjela za zaštitu djece, obitelji i braka centara za socijalnu skrb na području Grada Zagreba i Zagrebačke županije. Istraživanje je provedeno metodom polustrukturiranog intervjua. U obradi podataka korištena je tematska analiza. Rezultati istraživanja pokazuju da stručnjaci u svakodnevnom radu u situacijama ugrožene dobrobiti djeteta prepoznaju različite simptome afektivne nestabilnosti, impulzivnog i nekontroliranog ponašanja, smetnji identiteta, nestabilnih i intenzivnih interpersonalnih odnosa te teškoća testiranja realnosti koje su potencijalno povezane s mogućim graničnim poremećajem ličnosti roditelja. Kao otežavajuću okolnost u radu s ovim roditeljima stručnjaci iz centara za socijalnu skrb navode poteškoće suradnje sa stručnjacima iz zdravstvenog sustava.
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.
PDF
