Bolnički dio sustava skrbi za psihičko zdravlje izložen je svim izazovima sigurnosti kao i drugi dijelovi bolničkoga zdravstvenog sustava, no mimo njih izložen je i dodatnim, jedinstvenim izazovima ...sigurnosti, od kojih je jedan svakako povezan s pružanjem skrbi za suicidalne bolesnike. Kao krajnja pojavnost kontinuuma suicidalnosti – samoubojstvo, posebice u bolničkom sustavu skrbi, može predstavljati valjani pokazatelj sigurnosti pružene skrbi. To prepoznaje i pravni okvir u Republici Hrvatskoj koji pokušaj samoubojstva i samoubojstvo razvrstava u neočekivani neželjeni događaj. Međutim, nastojanje sprječavanja (prevencije) samoubojstava i pokušaja samoubojstava bremenito je mnogobrojnim izazovima, a koje u ovom preglednom radu prikazujemo kroz nekoliko međusobno isprepletenih (pod)cjelina: procjenu i predviđanje suicidalnosti (to jest, opasnost od samoubojstva), prijam na bolničko liječenje, liječenje i nadzor tijekom bolničkog liječenja, otpust s bolničkog liječenja te daljnje praćenje po otpustu. Unatoč svim izazovima, sprječavanje samoubojstava je središnji izazov sigurnosti bolesnika u bolničkom sustavu skrbi za psihičko zdravlje.
Our aim was to analyze the association of HSPA1B genotypes and treatment response measured by the changes of psychopathology and neurocognitive symptoms in patients with first-episode psychosis (FEP) ...after 18 months of treatment. A sample of 159 patients with FEP admitted at two Croatian psychiatric hospitals in the period between year 2014 and year 2017 was assessed at baseline and after 18 months of follow-up with Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS) and a battery of neurocognitive tests. Associations of scale and test results with HSPA1B polymorphic locus rs1061581 were analyzed using the general linear model. The carriers of the AA genotype showed the highest improvement in CDSS and RAVLT A test after the 18-month follow-up. Concordantly, we found significantly higher improvement assessed with the CDSS, RAVLT A, RAVLT A 30' and positive PANSS scales in the not-GG (AA/AG) group compared with the GG group. Our study suggests that HSPA1B rs1061581variants may moderate treatment response in FEP measured with changes of psychopathology and neurocognitive test results.
To analyze the difference in the salivary cortisol response to psychosocial stress between the patients with the first episode of psychosis (FEP) and the control group.
We performed a cross-sectional ...analysis of the baseline measurements of a prospective cohort study conducted from 2015 to 2018 at two Croatian psychiatric hospitals. The study consecutively enrolled 53 patients diagnosed with FEP and 63 healthy controls. The primary outcome was the difference in the changes of salivary cortisol concentration during the stress test. The secondary outcome was the difference in the baseline levels of salivary cortisol between patients with FEP and controls. The tertiary outcome were the correlations of salivary cortisol levels with the results of the Positive and Negative Syndrome Scale for Schizophrenia, Rosenberg Self-Esteem Scale, and the International Personality Item Pool.
Patients with FEP had significantly higher baseline salivary cortisol than controls, but their salivary cortisol increased significantly less during the stress test.
Patients with FEP respond differently to stressful stimuli than controls, as shown by the increased baseline salivary cortisol and blunted cortisol response, possibly indicating a greater vulnerability to psychosocial stress.
Pandemija COVID-19 svojim utjecajem na tjelesno zdravlje te kao potencijalna životna ugroza ima značajne reperkusije na mentalno zdravlje u smislu posljedičnog psihološkog distresa i pojave simptoma ...psihičkih poremećaja. Navedeni utjecaj je dodatno otežan mjerama socijalne izolacije kao jednim od načina sprječavanja širenja pandemije. Utjecaj pandemije na oboljele od anksioznih i depresivnih poremećaja može se manifestirati kroz inadekvatnu i maladaptivnu prilagodbenu reakciju koja rezultira pretjeranom tjeskobom ili pak pogoršanjem simptoma osnovnog poremećaja, odnosno recidivom poremećaja. S druge strane, oboljelima značajno otežava baštiniti i pozitivne strane adaptacijskog naprezanja u smislu jačanja otpornosti, odnosno fleksibilnosti zdravih snaga ličnosti. Gledajući s aspekta oboljelih od anksioznih i depresivnih poremećaja u okviru ove pandemije, nameće se potreba za akceptiranjem činjenice kako se radi o vulnerabilnoj populaciji kojoj je potrebno osigurati promptnu i što obuhvatnije organiziranu dostupnost kontinuirane psihijatrijske skrbi.
Antipsychotic-induced weight gain and metabolic abnormalities are one of the major challenges in the treatment of psychosis, contributing to the morbidity, mortality and treatment non-adherence. ...Different approaches were used to counteract these side effects but showed only limited or short-term effects. This study aims to analyse the effects of a long-term multimodal treatment program for first episode psychosis on antipsychotic-induced metabolic changes.
We enrolled 71 patients with first episode psychosis treated at the Zagreb University Hospital Centre from 2016 until 2018. Participants were assigned to one of the two groups: day hospital program vs. treatment as usual (TAU). Outcomes were: body weight, blood glucose, lipids and cholesterol, psychopathology and global level of functioning during the 18-months follow-up.
Although the TAU group gained more weight and had higher increase of blood glucose, while the day hospital group had a higher increase in total cholesterol at 18th month follow-up, after the adjustment for age, gender and baseline measures, the type of treatment was not significantly associated with any of the primary outcome measures. Patients' psychopathology measures significantly decreased and their functional level significantly increased at month 18th in both groups.
While both types of treatment were effective in reducing psychopathology and restoring the patients' level of functioning, both were relatively ineffective in counteracting antipsychotic-induced metabolic abnormalities and antipsychotic-induced weight gain.
•Patients with FEP performed significantly worse than HC in all cognitive domains.•There are differences in the long-term course of domain-specific cognitive deficits.•Treatment can help to improve ...the majority of domain-specific deficits in FEP.•However, despite the improvement, neurocognitive status in FEP was still below HC.•Verbal and executive deficits remained unchanged after 18 months of treatment.
Neurocognitive symptoms exert the most influence on treatment outcomes over the course of schizophrenia, starting from the first-episode of psychosis (FEP) onwards. Our aim was to analyze the neurocognitive status of FEP compared to healthy controls (HC), and its change after 18 months of treatment. We performed a study in a sample of 159 patients with FEP and 100 HC. We followed the patients up for 18 months after initial assessment with a battery of neurocognitive tests. We observed statistically significant improvement in the majority of neurocognitive tests after 18 months, but several tests of specific neurocognitive domains (verbal memory, language functions, executive functions) did not show significant differences between the two assessments. The results for the majority of tests obtained from patients with FEP after 18 months of treatment showed significant deterioration compared with HC. Although our study showed significant improvement of baseline neurocognitive deficits in FEP with treatment, this varied across domains and overall performance remained below that of HC. Thus, while it seems that treatment of FEP may help to delay or restore neurocognitive deterioration, it is unclear whether specific areas of neurocognitive deterioration (e.g. verbal domain) would benefit from more time or specific treatment approaches.
The aim of our study was to assess the differences in facial emotional recognition (FER) between patients with first-episode psychosis (FEP), patients with multi-episode schizophrenia (SCH), and ...healthy controls (HC) and to find possible correlations of FER with psychopathology in the two patient groups.
We performed a cross-sectional study enrolling 160 patients from two psychiatric hospitals in Croatia (80 FEP and 80 SCH) and 80 HC during the period from October 2015 until October 2017. Patients were assessed once during their hospital treatment, using the Penn Emotion Recognition Task for assessment of FER, rating scales for psychopathology and depression and self-reporting questionnaires for impulsiveness, aggression, and quality of life.
The number of correctly identified emotions significantly decreased from HC to FEP Δ -7%; 95% confidence interval (CI) -12% to -3%, effect size r = 0.30 and more markedly in SCH (Δ -15%; 95% CI -25% to -10%, effect size r = 0.59) after the adjustment for age and gender and correction for multiple testing. Correct FER for negative emotions, but not for happiness and neutral emotions, had a statistically significant negative correlation with some features on the scales of psychopathology, impulsivity and aggression in both patient groups.
Impairment of FER is present from the first episode of schizophrenia and increases further with multiple psychotic episodes, but it may depend on or contribute to clinical symptoms. Therefore, assessment of FER should be included in the clinical assessment and integrated in the plan of treatment from the beginning of the illness. (JINS, 2019, 25, 165-173).
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