The prolonged stress experience caused by the COVID-19 pandemic and two earthquakes led to increased alcohol and psychoactive substance use (PSU) accompanied by a decrease in mental wellbeing and ...quality of life (QoL) in the Croatian population. Our aim was to determine the relationship between alcohol and PSU and mental health outcomes including anxiety and depression, and QoL.
A cross-sectional online survey conducted from September 30 to October 27, 2021, included 1,118 Croatian adults (220 men and 898 women; mean age, 35.1 ± 12.3 years) recruited through non-probabilistic convenience sampling. The survey consisted of a self-reported questionnaire on PSU, the CAGE Alcohol Questionnaire, the Hospital Anxiety Depression Scale, and the World Health Organization Quality of Life (WHOQoL)-BREF. Structural equation modeling was used to evaluate the association between PSU, problematic alcohol use (PAU), mental health outcomes, and QoL.
The model demonstrated a good fit and indicated that PSU increase, PAU, and anxiety and depression symptoms significantly explained all QoL domains (
< 0.001 for all). Both PSU increase and PAU during prolonged stress were directly associated with decreased QoL. These relationships were also indirectly mediated through increased anxiety and depression symptoms.
These results showed the need to direct public health interventions and treatment interventions during and after long-term stress (pandemics and earthquakes) to reduce the negative impact on substance use and QoL by reducing depression and anxiety, which ultimately may contribute to better wellbeing and rapid recovery of individuals affected by prolonged stress.
Purpose
While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient ...demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients and of shared indicators on forensic care within Europe is an obstacle to comparative research. The reasons for such variation are not well understood.
Methods
Experts from seventeen EU states submitted data on forensic bed prevalence rates, gender distributions and average length of stay in forensic in-patient facilities. Average length of stay and bed prevalence rates were examined for associations with country-level variables including Gross Domestic Product (GDP), expenditure on healthcare, prison population, general psychiatric bed prevalence rates and democracy index scores.
Results
The data demonstrated substantial differences between states. Average length of stay was approximately ten times greater in the Netherlands than Slovenia. In England and Wales, 18% of patients were female compared to 5% in Slovenia. There was a 17-fold difference in forensic bed rates per 100,000 between the Netherlands and Spain. Exploratory analyses suggested average length of stay was associated with GDP, expenditure on healthcare and democracy index scores.
Conclusion
The data presented in this study represent the most recent overview of key epidemiological data in forensic services across seventeen EU states. However, systematically collected epidemiological data of good quality remain elusive in forensic psychiatry. States need to develop common definitions and recording practices and contribute to a publicly available database of such epidemiological indicators.
To determine the differences between aggressive and non-aggressive alcoholics in sociodemographic and clinical characteristics and ego strength.
This cross-sectional study included 111 aggressive and ...123 non-aggressive male alcoholics aged between 25 and 60 years who were admitted to the Department for Alcoholism, University Psychiatric Hospital Vrapče, Zagreb, Croatia, from January to December 2016. All participants met the diagnostic criteria for alcohol dependence according to the Croatian Mini International Neuropsychiatric Interview (MINI), 4th revised edition of Diagnostic and Statistical Manual of Mental Disorders, and the International Classification of Diseases. Participants were clinically assessed by an experienced psychiatrist using a clinical interview, MINI, Questionnaire from the Brown-Goodwin Lifetime History of Aggression, and Ego Identity Scale (EIS) according to Erikson. A clinical psychologist performed cognitive function measurements. EIS scores were analyzed using one-way analysis of variance.
In comparison with non-aggressive alcoholics, aggressive alcoholics were more often divorced, unemployed, hospitalized, and first treated for alcoholism at an earlier age (P<0.05 for all). They more frequently experienced depression (42.4% vs 19.4%, P=0.013) and attempted suicide (34.7% vs 6.2%, P=0.003), achieved a lower level of maturity at the second stage of psychosocial development related to shame and doubt (14.0±4.1 vs 17.4±3.7, P=0.013) and at the fourth stage related to inferiority (13.1±6.8 vs 18.1±9.3, P=0.011), and had lower total EIS score (75.8±20.4 vs 85.2±21.5, P<0.012) than non-aggressive alcoholics.
Aggressive alcoholics had weaker ego-strength than non-aggressive alcoholics, experienced more depressive reactions and suicide attempts, and showed poorer psychosocial functioning. Oxford Centre for Evidence-based Medicine level of evidence: 3*.
To compare the frequency of alleles and genotypes in brain-derived neurotrophic factor (BDNF) val66met polymorphism in ethnically homogenous Caucasian (from Croatia) and ethnically homogenous Asian ...(from South Korea) healthy participants, as inter-population differences in BDNF val66met may be responsible for the divergent findings in genetic and association studies.
BDNF val66met was genotyped in 800 (556 Croatian and 244 Korean) healthy participants. Frequencies of alleles and genotypes were evaluated using a chi(2) test.
The frequencies for genotypes (chi(2)2=114.69; P<0.001) and alleles (chi(2)1=120.07; P<0.001) between Korean and Croatian individuals differed significantly, due to significantly lower (46.3% and 19.5%, P<0.001) frequency of "Met" allele and significantly higher (53.7% and 80.5%, P<0.001) frequency of "Val" allele in Croatian than in Korean participants.
The study found significant ethnic differences in BDNF val66met polymorphism. The most frequent genotype among Korean participants was "Met/Val" and they had similar distribution of "Met" and "Val" alleles. In contrast, the most frequent genotype among Caucasian participants was "Val/Val" and they had different distribution of "Met" and "Val" alleles. These ethnic differences require matching participants for ethnicity in pharmacogenetic studies and in the studies investigating genetic variations in neuropsychiatric disorders.
Lamotrigine is an antiepileptic drug with broad spectrum of actions, also approved for the treatment of bipolar disorder. Growing number of reports document the antiaggressive effect of lamotrigine ...in various psychiatric diseases. However, there has been only 1 study in the literature investigating the role of lamotrigine in posttraumatic stress disorder (PTSD), but its antiaggressive aspect was not observed. Although aggression is commonly associated with PTSD, there is paucity of data considering its management. We report a case of a patient with treatment-resistant PTSD, whose aggressive outbursts dominated his clinical picture and which were greatly improved after introducing lamotrigine in therapy. Our case suggests that lamotrigine may be useful in treating aggression and aggression-related symptoms in PTSD.
In a cross-sectional study, we measured the impact of the first three COVID-19 pandemic waves and two earthquakes, occurring during the same period in Croatia, on the quality of life (QoL) of the ...general adult population. An online survey consisting of sociodemographic questions, questions related to COVID-19 and earthquake stressors, the World Health Organization Quality of Life (WHOQoL)-BREF scale, Impact of Event Scale, and Patient Health Questionnaire 4 was completed by 220 men and 898 women (mean age, 35.1 ± 12.3 years). In a series of regressions, we examined the association among five blocks of predictors and six dependent QoL variables, four domain scores, and two global scores. Both WHOQoL-BREF global and domain scores after the prolonged stress were significantly predicted by anxiety, depression, stress symptoms, and sociodemographic characteristics. COVID-19-related stressors predicted significantly physical and psychological health, social relationships, and environmental QoL, whereas earthquake-related stressors predicted health satisfaction, physical and psychological health, and environmental QoL.
Background
During the COVID-19 pandemic and concomitant earthquakes in Croatia in 2020, increased Internet use (IU) and Internet-based addictive behaviors were associated with decreasing mental ...well-being. We determined the changes in IU, problematic IU (PIU), and problematic specific Internet activities in young adults during the prolonged stress caused by the pandemic and earthquakes, age differences in PIU and differences in perceived source of stress (pandemic or earthquakes), and association between PIU and increase in specific Internet activities and stress, anxiety, and depression symptoms in young adults.
Methods
A cross-sectional online survey conducted from September 30, 2021 to October 17, 2021 included 353 young adults aged 22.6 ± 2.1 years, 382 early adults aged 32.1 ± 4.4 years, and 371 middle-aged adults aged 49.0 ± 6.5 years. Data on sociodemographic characteristics, stressors (without perceived stressors, only pandemic-related stressor, only earthquake-related stressor, and both pandemic and earthquake-related stressors), PIU and IU were collected with a self-report questionnaire. The Impact of Event Scale and the Hospital Anxiety Depression Scale were used to evaluate mental symptoms. PIU and problematic specific Internet activities were assessed using Tao et al.’s criteria. Data were anaylzed with paired-sample Wilcoxon test, McNemar’s and Pearson’s chi-square tests, and structural equation modeling.
Results
In 17% of young adults, we found increased PIU (OR = 5.15, 95% CI 2.82, 10.18), problematic social media use (OR = 2.77, 95% CI 1.56, 5.14), and uncontrolled online shopping (OR = 5.75, 95% CI 1.97, 22.87) (
p
< 0.001 for all). PIU and problematic social media use were more common among young adults (60.8%), as well as problematic online gaming (25.9%). Problematic social media use was more frequent among young adults reporting pandemic stress than among those without perceived stress (69.9% vs. 43.2%). Increased online gaming predicted more severe avoidance symptoms (
p
= 0.041), increased social media use predicted more severe depression symptoms (
p
= 0.017), increased online shopping predicted more severe intrusion (
p
= 0.013) and anxiety symptoms (
p
= 0.001). PIU predicted more severe intrusion (
p
= 0.008), avoidance (
p
= 0.01), anxiety (
p
< 0.001), and depression (
p
= 0.012) symptoms.
Conclusion
Different effects of the pandemic and earthquakes on IU could reflect a different effect of various stressors on Internet behavior of young adults. Type of problematic Internet behavior may predict for the type of mental health problem.
Croatia is a European country with one of the highest prevalence of domestic violence (DV) against women and without a strategy related to male victims. DV against men is a problem often overlooked ...and associated with numerous stereotypes. This study examines gender differences of DV help-seekers and specificities related to men. Data were derived through structured face to face interviews specifically designed for this study which based on DV literature that included 3296 help-seeking interviewees who personally visited the Counseling Center for Domestic Violence Victims, Zagreb, Croatia. Mental health professionals collected data on gender differences of help-seekers, socio-demographic characteristics, types, and duration of violence, perpetrators, and types of interventions. Important predictors of the gender of DV help-seekers were age, educational level, marital status, and DV types, duration and reporting. Women were more commonly abused by current partners and men by parents. Female victims were more likely to seek help after years of sustaining DV while male victims would seek help after up to 6 months of abuse. Women were more often victims of physical, financial, and multiple-type abuse, and men were more likely to suffer psychological abuse. Men were less likely to report abuse to the police, and misdemeanor or felony courts, but they sought legal counseling. 25% of DV help-seekers were men. Gender differences between victims of DV were in the socio-demographic characteristics, types and duration of violence, and perpetrators. Men underreported DV to institutions but they sought legal counseling. Additional practice and research implications are discussed.
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that develops after a psychological trauma usually caused by a situation perceived as deeply threatening to a person's life or ...integrity. Complex neurobiological changes triggered by such a traumatic and stressful experience may explain a wide range of PTSD symptoms and provide the rationale for psychopharmacological treatment. Selective serotonin-reuptake inhibitors make the first-line treatment of PTSD. Clinical experience has shown that they are more effective than noradrenalin-reuptake inhibitors or tricyclic antidepressants. Antipsychotic drugs, especially atypical ones, have been shown effective in PTSD patients with psychotic characteristics or refractoriness to other treatments. Mood stabilizers seem to reduce mostly autonomous overreactions to stress, whereas the evidence for effectiveness of monoamine oxidase inhibitors is largely inconclusive. Other groups of medications, such as serotonin agonists and antagonists, new antidepressants, dual inhibitors of serotonin- and noradrenalin-reuptake, anticonvulsants, and opiate antagonists are also sometimes used in PTSD treatment. However, as shown in the present review, most clinical studies performed to date to investigate the effectiveness of different psychopharmacological agents in the therapy of PTSD have serious limitations in terms of small sample size, lack of blinding and randomization, and small effect size. More rigorously designed, comparative studies are needed to determine the usefulness, efficacy, tolerability, and safety of particular psychopharmaceutical drugs in the treatment of this therapeutically and functionally challenging disorder.
Increased prevalence and severity of both substance and behavioral addictions are among the most harmful consequences of the COVID-19 outbreak.
To determine the sociodemographic characteristics, ...COVID-19-related stressors, and stress, anxiety, and depression symptoms that may predict the use and changes in the use of psychoactive substances (PS) during the first three COVID-19 waves in Croatia.
The cross-sectional online survey included 1,118 adult participants (220 men and 898 women; mean age: 35.1 SD = 12.3 years; age range: 18-78) from general adult population. Sociodemographic data were collected, and ad-hoc developed questionnaires on COVID-19-related stressors, PS use before and during the pandemic, CAGE Alcohol Questionnaire, Impact of Event Scale, and Hospital Anxiety Depression Scale were applied.
The PS use increased in 31% of participants. The use of tobacco, caffeine, alcohol, cannabinoids, and anxiolytics showed the greatest increase in the last year (tobacco 7.1%; caffeine 5.8%; alcohol 6.4%; cannabinoids 2.5%; and anxiolytics 3.9%). Alcohol consumption during the pandemic increased in 16.8% of participants who consumed alcohol before the pandemic, with 4.5% of them reporting problematic alcohol use (PAU). The tested model demonstrated relatively good model-data fit and significantly predicted 11.8% increase in the use of PS and 9.8% of PAU.
Being married or in a relationship and severe anxiety and depression symptoms predicted increased use of PS and PAU, while higher education level and ever being diagnosed with COVID-19 predicted only increased use of PS.
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