Branka Aukst-Margetić

Perception of Stigmatization in Forensic Patients With Schizophrenia

Background: The literature about perceived stigmatization of forensic patients with schizophrenia is sparse. Aims: To examine relations between the perceived stigmatization of forensic patients with schizophrenia and the intensity of the symptoms, age, regular home visiting, kind of offence, perceived family support and duration of hospitalization. Method: Sixty-two male forensic patients with schizophrenia were included. Perceived stigmatization was measured by the modified questions from the World Health Organization Disability Assessment Schedule II. Symptomatology was assessed with the Positive and Negative Syndrome Scale. Perception of family support was assessed with a visual-analogue scale. Due to different characteristics of offences and possibilities for home visiting, patients were divided into groups of those who had committed violent and non-violent offences, and those with and without the possibility of regular home visiting. Results: Symptoms have an impact on the perception of stigma. The kind of offence committed does not have a significant role in the perception of discrimination. Age was negatively correlated with the perception of stigma. Conclusion: Results might have significance for a better understanding of social relations between forensic patients and their environment and provide us with information about institutionalized forms of stigma. Results might have implications for the treatment and the quality of life of these patients.

Neuroleptic malignant syndrome and clozapine withdrawal at the same time

The authors report a case of a patient, who in a few days after an abrupt discontinuation of clozapine and haloperidol developed agitated and confused state resembling neuroleptic malignant syndrome (NMS) and clozapine withdrawal symptoms at the same time. Data obtained from family members led to gradual reintroduction of clozapine and to subsequent recovery. The case illustrates the importance for clinicians to be familiar with the variety of discontinuation symptoms, so they can recognize them and offer effective treatment.

An open-label series using loratadine for the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors

OBJECTIVE To assess the impact of loratadine as an add-on treatment of erectile dysfunctions associated with selective serotonin reuptake inhibitors (SSRIs). METHODS Nine patients diagnosed as major depressive disorder (MDD), with erectile dysfunction associated with the administration of SSRIs, completed a 2-week trial of loratadine in the dose of 10 mg/day. The International Index of Erectile Function Five (IIEF-5) was used as an assessment measure for diagnosing the presence and severity of erectile dysfunction. The 17-item Hamilton Rating Scale for Depression (HAM-D) was administered for screening the potential impact of depressive symptoms. RESULTS Baseline mean S.D.+/-IIEF-5 scores were 10.33+/-4.55 (range 5-20) and week 2 mean+/-S.D. IIEF-5 was 14.44+/-3.84 (range 10-22). Subjects had statistically significant improvement in their erectile functions on the IIEF-5 (t = -8.485; df = 8; p = 0.000) and 55% reported subjective improvement of the erectile function. No significant changes on HAM-D 17 scores were registered. Baseline mean S.D. scores were 13.66+/-2.29 (range 10-17) and week 2 mean S.D. was 13.11+/-1.96 (range 10-16) (t = 1.47; df = 8; p = 0.179). CONCLUSION Our findings suggest the possible role of loratadine in the treatment of SSRI-associated sexual dysfunction. They are promising, but preliminary. Thus they should be replicated in a longer large-scale, double-blind, placebo-controlled trial.

Psychometric properties and factor structure of the Temperament and Character Inventory-Revised (TCI-R) in a Croatian psychiatric outpatient sample

OBJECTIVE The goal of this study was to investigate psychometric properties and factorial structure of the Croatian adaptation of the Temperament and Character Inventory-Revised (TCI-R) in a sample of psychiatric outpatients (n=328). METHOD The participants filled out the TCI-R, as well as self-report measures of the Big-Five personality traits (IPIP-50), trait impulsivity (BIS-11), depression (BDI-II), suicidality (SBQ-R), and life satisfaction (SWLS). We explored the internal consistency of 7 domains and 29 subscales and compared it with the Croatian version of the original TCI used in prior studies. Principal component analysis with promax rotation was conducted on temperament and character subscales separately, while concurrent validity was examined through the TCI-Rs relations with the abovementioned psychological measures. RESULTS The TCI-R scales showed adequate internal consistencies, with Cronbachs alpha values ranging from 0.77 to 0.93. The internal consistency showed to be higher in comparison with the Croatian version of the original TCI. The postulated four-factor structure of temperament and the three-factor structure of character were confirmed. The meaningful associations with other measures supported the concurrent validity of the TCI-R. CONCLUSION The Croatian adaptation of the TCI-R exhibited satisfactory reliability and validity in a sample of psychiatric outpatients. These findings support the use of the TCI-R in Croatian clinical settings over its predecessor (TCI).

A different hypothesis on hyponatremia in psychiatric patients: Treatment implications and experiences

Polydipsia, chronic or intermittent, with or without hyponatremia, frequently occurs among chronic patients with schizophrenia. The pathogenesis of polydipsia remains poorly understood. The key assumption of our hypothesis is that in some of these patients, polydipsia and hyponatremia are consequences of patients’ adjustment to a prolonged intake of an insufficient diet, dominantly poor in potassium. Deficits of potassium, without significant hypokalemia, may cause impairment of the urine-concentrating ability with polyuria-polydipsia. A fall of intracellular tonicity, dominantly due to a decreased amount of K+ and attendant anions in cells, should be accompanied with a fall of extracellular osmolality. Because of the diminished content of ions that may diffuse out of cells and because osmotic equilibrium between the ECF and ICF compartments cannot be established in a short period of time, these patients have a diminished ability to adapt to an excessive intake of fluids. These mechanisms might be related to the development of polydipsia and water intoxication in patients with different mental and somatic disorders. The experiences with the therapeutic effects of diets containing an sufficient amount of potassium in two patients with schizophrenia are described. Further investigations are needed, and we suggest a possible approach to test our hypotheses.

Monoamine Oxidase A Gene Methylation and Its Role in Posttraumatic Stress Disorder: First Evidence from the South Eastern Europe (SEE)- PTSD Study

Abstract Background Posttraumatic stress disorder is characterized by an overactive noradrenergic system conferring core posttraumatic stress disorder symptoms such as hyperarousal and reexperiencing. Monoamine oxidase A is one of the key enzymes mediating the turnover of noradrenaline. Here, DNA methylation of the monoamine oxidase A gene exonI/intronI region was investigated for the first time regarding its role in posttraumatic stress disorder risk and severity. Methods Monoamine oxidase A methylation was analyzed via direct sequencing of sodium bisulfite-treated DNA extracted from blood cells in a total sample of N=652 (441 male) patients with current posttraumatic stress disorder, patients with remitted posttraumatic stress disorder, and healthy probands (comparison group) recruited at 5 centers in Bosnia-Herzegovina, Croatia, and the Republic of Kosovo. Posttraumatic stress disorder severity was measured by means of the Clinician-Administered Posttraumatic Stress Disorder Scale and its respective subscores representing distinct symptom clusters. Results In the male, but not the female sample, patients with current posttraumatic stress disorder displayed hypermethylation of 3 CpGs (CpG3=43656362; CpG12=43656514; CpG13=43656553, GRCh38.p2 Assembly) as compared with remitted Posttraumatic Stress Disorder patients and healthy probands. Symptom severity (Clinician-Administered Posttraumatic Stress Disorder Scale scores) in male patients with current posttraumatic stress disorder significantly correlated with monoamine oxidase A methylation. This applied particularly to symptom clusters related to reexperiencing of trauma (cluster B) and hyperarousal (cluster D). Conclusions The present findings suggest monoamine oxidase A gene hypermethylation, potentially resulting in enhanced noradrenergic signalling, as a disease status and severity marker of current posttraumatic stress disorder in males. If replicated, monoamine oxidase A hypermethylation might serve as a surrogate marker of a hyperadrenergic subtype of posttraumatic stress disorder guiding personalized treatment decisions on the use of antiadrenergic agents.

Harm avoidance moderates the relationship between internalized stigma and depressive symptoms in patients with schizophrenia

This study investigated the associations between internalized stigma, depressive symptoms, and temperament dimension Harm avoidance. One hundred and seventeen stable outpatients with schizophrenia completed a battery of self-report instruments. Internalized stigma was significantly positively related to depressive symptoms, while Harm avoidance moderated the internalized stigma-depressive symptoms relationship.

Stuttering as a side-effect of divalproex sodium

STUTTERING IS DEFINED in DSM-IV as a disturbance in the normal fluency and time patterning of speech, characterized by frequent occurrences of one or more of the following: sound and syllable repetitions, sound prolongations, interjections, broken words, audible or silent blocking, circumlocutions, words produced with an excess of physical tension, and monosyllabic whole-word repetitions. There are two kinds of stuttering: developmental, and acquired. Acquired stuttering can occur at all ages and can be caused by pharmacological agents. Divalproex sodium is an anti-epileptic drug that has diverse side-effects, but an extensive review of the literature has failed to show stuttering as one of the complications. In contrast, divalproex sodium was described as a potential treatment of stuttering in the case report by Mulder and Spierings. We present a case in which divalproex sodium was implicated as a potential cause of stuttering. The patient was a 45-year-old man who had a 10-year history of post-traumatic stress disorder and alcoholism, and was otherwise healthy. He had been treated with citalopram 30 mg/day and promazine 100 mg/day for more than 3 months, but because of affective instability and irritability divalproex sodium was added at 600 mg/day. Four days later he complained of stuttering that was characterized by sound repetitions and prolongations that were not restricted to the initial syllable and that caused pronounced difficulty in starting and completing his sentences. Stuttering occurred in the initial, middle, and final position in the sentence, and was progressively worsening. It was obvious regardless of the situation. He was not confused or cognitively impaired during stuttering. Divalproex sodium was the only therapy added, so it was discontinued. Threedays later his speech returned to normal. The patient gave informed consent for the publishing of this paper, which is the first to implicate divalproex sodium as a potential cause of stuttering. We are aware of a few reports of stuttering associated with the use of selective serotonin re-uptake inhibitors and the use of phenothiazines. Thus, it is possible that stuttering was a consequence of the direct influence of divalproex sodium on speech, but also that divalproex sodium induced stuttering by influencing the pharmacokinetic properties of promazine or citalopram. Further research is required to clarify the mechanism of drug-induced stuttering.

Do spirituality and religiousness differ with regard to personality and recovery from depression? A follow-up study

BACKGROUND The studies show that both spirituality and religiousness are protective for mental health. Personality is related with course and outcome of depression, as well as spirituality and religiousness, and their relations toward to recovery from depression are underresearched. This study followed influence of spirituality and religiousness on course and outcome of depression in patients with depressive episode, controlled for personality dimensions. METHODS The patients were assessed with self-report measures of depression (Beck Depression Inventory), spirituality (WHO-Quality of Life-Spiritual, Religious, Personal Beliefs), religiousness (Duke University Religion Index) and personality (Temperament and Character Inventory). Ninety nine patients finished a year long follow up. RESULTS Higher spirituality influenced recovery of depression in patients with depressive episode, but religiousness did not show to be significant predictor of recovery for depression. Dimension harm avoidance was significant predictor of improvement of depression in all points of measurement. LIMITATIONS Some limitations of this research are small sample size, usage of the self-report measures of depression in follow-up period, and the predominantly Catholic affiliation of the participants that can impact the generalizability of our data to other denominations. CONCLUSION Spirituality and dimension harm avoidance are significant predictors of recovery from depression during a year long follow up.

Spirituality and Its Relationship with Personality in Depressed People: Preliminary Findings.

The relationship between spirituality and personality in patients with depression is complex and not much explored. The aim of our study is to examine the interconnection between the spiritual quality of life (QoL) and Cloninger’s psychobiological model of personality in patients with depression. The sample consisted of 85 consecutive outpatients treated for depression. The measurements used were: Beck Depression Inventory, WHO-Quality of Life-Spiritual, Religious, Personal Beliefs, and Temperament and Character Inventory. The results have shown that higher harm avoidance, lower self-directedness and lower cooperativeness are personality dimensions associated with depression. The spiritual QoL has showed to play a significant role in depression, just as it has proved to be a unique predictor of lower depressive symptoms, adjusted for personality dimensions. The spiritual QoL itself is predicted by personality dimensions, self-directedness and self-transcendence implying that spirituality is a broader construct than the character dimension. Our findings may contribute to a more comprehensive understanding of depression, spirituality and personality.