Delusional infestation (DI) is a rare psychiatric disorder characterized by a persistent false belief that one is infected with nonliving or living pathogens, usually accompanied by formication. ...Other psychotic features, such as disorganized speech or hallucinations unrelated to the core delusion itself, are never present, and the delusional belief does not extend into other areas of life. Secondary DI, when one needs to address the underlying condition in order to achieve adequate treatment, is also possible. We present the case of a 42-year-old male with a 2-year history of having a persistent and firm belief that his house was infested with tiny insects that were constantly biting him and laying their eggs under his skin. His delusional belief was preceded by a complex, years-long substance use disorder, which confronted us with a differential diagnostic dilemma between primary and secondary DI. He was successfully treated with olanzapine pamoate depot, which was introduced to address his lack of insight and unsatisfactory compliance, and his delusion faded away after his symptoms subsided.
The aim of this study was to determine the characteristics of psychiatric inpatients who committed suicide in the Vrapce Psychiatric Hospital with respect to clinical, ethical, and legal context. The ...study included all patients hospitalized in the Vrapce Psychiatric Hospital between 1 January 1996 and 31 December 2006 who committed suicide (n = 25). The suicide rate in the observed period was 32.9 per 100.000 (suicide coefficient, 50), which is similar that in general population. Based on the characteristics of hospitalized patients who committed suicide, we obtained a typical profile as follows: a middle-aged person, single, unemployed, repeatedly hospitalized, with schizophrenia and a history of suicide attempts, committing suicide using a violent method after more than three weeks of hospital treatment. If further prevention of hospital suicide will be treated as a legal rather than medical issue, the hospital atmosphere would be totalitarian rather than therapeutic. The success of psychiatric treatment is the perception of both of these aspects of suicide as well as their efficient balancing.
U radu autori, potaknuti nedavno održanim izborima za predsjednika Republike Hrvatske iznose postavke kontekstualno povezane s područjem ponašanja potrošača promatranih ovom prilikom iz perspektive ...glasača. Budući da je svakog korisnika usluge ujedno moguće terminološki odrediti i kao potrošača, tako je, analogno iznesenoj tvrdnji, a u okviru područja političkog marketinga, moguće
svakog dionika demokratskog procesa glasovanja, odnosno glasača, definirati kao potrošača te u konačnici donositelja krajnje odluke — izići na biralište ili ne izići, glasovati za ili pak glasovati protiv. Pitanje koje se temeljem iznesenog u tom konkretnom slučaju nameće je priroda same motivacije glasača. Je li tu riječ o pozitivnoj ili negativnoj motivaciji glasača, o pozitivnoj ili negativnoj pokretačkoj
sili? Jesu li glasači glasovali za ili su pak glasovali protiv? Ta je dilema, između ostalog, ujedno i posljedica mnogobrojnih tvrdnji koje je bilo moguće iščitati iz hrvatskih medija, a koje bi se mogle sažeti u zaključak da su glasači zapravo glasovali protiv, odnosno da su bili negativno motivirani te time izrazili svoje nezadovoljstvo
postojećim socijalnim i ekonomskim stanjem u Republici Hrvatskoj
te da nisu uzimali u obzir ponuđeni program kandidata. U radu se detaljnije opisuje kontekst motivacije kao pokretačke sile potrošača, odnosno glasača — tom prilikom u kontekstu političkog marketinga, te se navode i uspoređuju tri najpoznatije teorije potrošačke motivacije. Analizom postojećeg stanja i metodom komparacije navedenih teorija autori dolaze do zaključka o snažnijem utjecaju
pozitivne motivacije na donošenje odluka glasača.
Prompted by the recent Croatian presidential elections, the authors have put forward propositions contextually related to the field of observed consumer behaviour from the voter’s perspective. Since each end–user can also be termed a consumer, analogous to this claim and as seen within the framework of political marketing,
each stakeholder in the democratic election process — that is, the voter — can be defined as a consumer and ultimately a final decision–maker: Should I go to the polls or not? Should I vote »for« or »against«? In this particular case, based on facts presented, the question arises as to the motivation of the voter: Is the voter positively or negatively motivated, or are we dealing with a positive or negative driving force? Have the voters voted »for« or »against«? Such a dilemma is a consequence, aside from other factors, of the many claims promoted by the Croatian media which can be summed up by saying that voters had in fact voted »against«. In other words, they were negatively motivated and thus expressed their dissatisfaction with the (former) current social and economic situation in the Republic of Croatia; furthermore, they did not take into account the programs put forward by presidential candidates. This
paper describes in detail the context of motivation as the consumer’s, or rather the voter’s driving force — this time in the context of political marketing. The three most well–known theories of consumer motivation are also cited and comparisons are drawn. Through an analysis of the current situation and comparisons among the
said theories, the authors have come to the conclusion that the impact of positive motivation upon the ultimate decision of the voter has prevailed.
In this article the authors present through theory and case reports on the phenomenon of glossolalia, the unusual vocal utterances that sound language-like. Sense, meaning and function of glossolalia ...are closely connected with social and cultural context, and therefore glossolalia is experienced as a normal and expected behavior in religious prayer groups, while in mental disorders it is considered a psychopathological symptom. Historic theological debates explain the pure spiritual etiology of glossolalia, while the current studies present the phenomenon of glossolalia as a result of learned behavior and training. Glossolalia occurs as an individual or a group phenomenon after which the speaker and the persons around him feel good, what is explained psychodynamically as a regression upon early developmental levels. In this temporary regression there is an explanation of positive, almost psychotherapeutic effect of glossolalia.
Unconfounded differences in inherent vulnerability to metabolic disturbance may be hypothesized for different diagnostic groups with severe mental illness.
A naturalistic cohort of patients diagnosed ...with DSM-IV bipolar disorder (N = 112), schizophrenia (N = 503), and schizoaffective disorder (N = 92) were assessed for metabolic disturbances. The prospective inclusions started in November 2003 and were concluded in July 2007.
Diagnosis was strongly associated with the metabolic syndrome (chi(2) = 14.90, df = 2, p < .001). Compared with bipolar patients, the unadjusted risk for metabolic syndrome was significantly higher for schizoaffective (odds ratio OR = 3.51, p < .0001) but not for schizophrenia patients (OR = 1.58, p = .094). Differences were not reducible to confounding factors including treatment. Rather, the difference between bipolar and schizophrenia patients also reached significance after adjustment (OR = 1.97, p = .046). Furthermore, the association between diagnosis and glucose dysregulation was significant (chi(2) = 6.97, df = 2, p = .031), with a significantly higher risk in schizoaffective (unadjusted OR = 2.12, p = .022) but not in schizophrenia patients (unadjusted OR = 1.13, p = .640) compared with bipolar patients. Diagnostic differences in glucose dysregulation were in part mediated by body mass index (BMI).
Schizoaffective patients in particular may be at risk for metabolic disturbances compared with bipolar and schizophrenia patients. Differences were not reducible to known metabolic risk factors and could only be explained in part by higher BMI in schizoaffective patients, suggesting an increased inherent vulnerability in this group.
Uvod: Problemi mentalnog zdravlja i mentalni poremećaji karakterizirani su visokom učestalošću kako u svijetu tako i u Republici Hrvatskoj. Osim visoke učestalosti, sama priroda mentalnih poremećaja, ...koja nerijetko zahvaća radno aktivno stanovništvo, značajno doprinosi opterećenju bolestima. Upravo navedeno zahtijeva sveobuhvatnu organizaciju skrbi za osobe oboljele od mentalnih poremećaja koja će uključivati sve mjere prevencije, liječenja i rehabilitacije. Cilj ovoga rada je prikazati stanje i trendove organizacije skrbi za osobe s mentalnim poremećajima u Republici Hrvatskoj te dati preporuke za unaprjeđenje skrbi sukladno rezultatima Twinning projekta: „Osiguravanje optimalne zdravstvene skrbi za osobe s poremećajima mentalnog zdravlja“. Metode: Za potrebe ovoga rada korišteni su podatci Hrvatskog zavoda za javno zdravstvo o broju i karakteristikama bolničkih liječenja za mentalne bolesti ukupno te za pojedinačne dijagnoze u razdoblju od 2000. do 2016. godine u Republici Hrvatskoj. Analizirane su usporedne dobnostandardizirane stope smrtnosti zbog samoubojstava u Republici Hrvatskoj i pojedinim zemljama Europe. Korišten su pregled literature povezano s ocjenom stanja organizacije psihijatrijske skrbi u Hrvatskoj i postojeće smjernice te objavljeni znanstveni radovi s opisom dobre prakse. U radu je korištena analitičko-deskriptivna metoda. Rezultati: Prema procjeni
opterećenja bolestima za Republiku Hrvatsku mentalni poremećaji su na trećem mjestu među vodećim skupinama bolesti. Osim toga, mentalni poremećaji su i vodeći uzroci bolničkog pobola u radno aktivnoj dobi, dok na razini primarne zdravstvene zaštite pobol iznosi oko 4-5 % od ukupnih uzroka obolijevanja. Dobno-standardizirane stope smrtnosti zbog samoubojstva za Republiku Hrvatsku su više od prosječne stope za zemlje članice Europske unije. Iako se bilježi kontinuirani pad bolnoopskrbnih dana od 2000. do 2016. godine, ukupni broj hospitalizacija u odnosu na 2000. godinu povećao što se poglavito
odnosi na depresivne poremećaje, a i oboljeli od shizofrenije vode u broju dana provedenih u bolnici. Prikazani su izolirani primjeri dobre prakse koji se odnose na rehabilitaciju oboljelih od poremećaja s psihozom, liječenje prvih psihotičnih poremećaja, bolesti ovisnosti te programi borbe protiv stigme i samostigme. Rasprava: Iz prikazanih pokazatelja može se zaključiti kako su mentalne bolesti sv e veći problem s obzirom na trend rasta stopa hospitalizacija kao i broj dana provedenih u bolnici. Zaključak: Potrebno je potaknuti reformu sustava mentalnog zdravlja prema izgradnji balansiranog i dobro koordiniranog bolničkog i izvanbolničkog sustava. Preporuke razvijene u okvirima Twining projekta mogu služiti kao smjernice za razvoj i provedbu na dokazima utemeljene i provedive strategije mentalnog zdravlja čiji će cilj biti oporavak koji uključuje socijalnu uključenost u život zajednice.
The authors discuss the frequency of indication for and the results of CT and MRI brain scans in patients hospitalized in Vrapce Psychiatric Hospital. They wanted to contribute to the solving of the ...dilemma whether neuroradiologic tests should be a part of a routine diagnostic procedure in all psychiatric patients. Retrospectively, on the basis of case histories, the patients were analyzed in the first nine months of 2006. In this period 90 CT brain scans and two MRI brain scans were done, most often in the patients who were treated under the diagnoses of endogeneous psychoses, psychoorganic syndrome (dementia), affective disorders and epilepsy. Most CT findings (59%) and both MRI findings were normal. Abnormal findings were most often described as various forms of brain atrophy. Only one brain tumor was found. Electroencephalographic findings quite more often differed significantly from normal in the patients with abnormal CT findings compared with the patients with normal CT findings. The conclusion is that very small number of positive findings, except the brain atrophy, does not give good reason for routine CT and MRI brain scan in all hospitalized psychiatric patients. Indication must be made selectively on the basis of clinical psychiatric-neurologic evaluation. EEG, with limitations, can be of help in this matter.
This study provides an overview of the incidence of smoking, the socio-demographic characteristics of Croatian smokers during a five-year period and an assessment of predictors of the desire/decision ...to quit smoking. Analyses were performed separately for 2003 and 2008. A total of 3,229 subjects were included in the survey. There is a significant trend of a decreasing number of smokers in all age groups in 2008, compared to 2003. Almost half of the smokers included in the study expressed desire to quit smoking. Factors contributing significantly to decision to quit smoking were different in
2003 and 2008, except one. Concern about the harmful effects of tobacco smoking on health was a significant predictor in both models. Very worried respondents were more likely to decide to quit smoking (OR 17.6, 95% CI 9.41 to 33.17 vs. OR 12.54; 95% CI 6.0 to 26.2) than those who were not worried at all.
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