Nikolina Jovanović

The role of impulsivity in self-mutilators, suicide ideators and suicide attempters — A study of 1265 male incarcerated individuals

OBJECTIVE We explored differences between high and low-impulsive incarcerated individuals in the context of lifetime self-mutilation, suicide ideation and suicide attempt. METHODS A total of 1265 males detained in Italian penitentiary institutions were studied between January 2006 and December 2008. The study raters were specifically trained to discriminate between suicide attempters, ideators and self-mutilators. Participants completed the Barratt Impulsivity Scale, Childhood Trauma Questionnaire (CTQ), Eysenck Personality Questionnaire (EPQ), Connor-Davidson Resilience Scale (CD-RISC), Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) and Buss and Durkee Hostility Inventory (BDHI). Based on BIS 7 total score distribution, two extreme quarters - high-impulsive group (n=306) and low-impulsive group (n=285) - were compared. RESULTS Over 42% of participants had lifetime suicide ideation, 13% attempted suicide and 17% were self-mutilators. High-impulsive subjects were younger, more often single and with more prominent psychoticism, extraversion, aggression, hostility and resilience capacity. They were more frequently diagnosed with substance use disorders and engaged in self-mutilating behaviour. There was no difference in the rate of suicide attempts between the two groups. CONCLUSION Although high-impulsive subjects were more prone to suicidal behaviour, it was not predicted by higher impulsivity when other psychological variables were accounted for.

Association study of MDR1 and 5-HT2C genetic polymorphisms and antipsychotic-induced metabolic disturbances in female patients with schizophrenia

The objective of this study was to determine the association of 5-HT2C (serotonin 2C receptor) and MDR1 (multidrug resistant protein) genetic polymorphisms and antipsychotic-induced metabolic abnormalities among female patients with DSM IV schizophrenia spectrum disorders. We have previously reported the associations of −759CT 5-HT2C and G2677T and C3435T MDR1 genetic polymorphisms and olanzapine/risperidone-induced weight gain in a similar sample of patients. Here, we included a total of 101 previously non-medicated female patients treated with olanzapine/risperidone over a 3-month period. The variables analyzed included fasting glucose, total cholesterol, low-density lipoprotein, high-density lipoprotein and triglyceride levels in blood, blood pressure and waist circumferences. We observed significant association of −759T 5-HT2C genetic variant and greater increase in waist circumference (P=0.03), fasting glucose level (P=0.046) and triglyceride level (P=0.045) in blood after a 3-month period. The 2677T and 3435T MDR1 genetic variants were significantly associated with the greater increase in fasting glucose level in blood when patients were using olanzapine (P<0.001 and P=0.028, respectively). Our data indicate a possible influence of −759CT 5-HT2C and MDR1 G2677T and C3435T MDR1 genetic polymorphisms on the development of metabolic abnormalities among female patients treated with olanzapine/risperidone.

Challenges for trainees in psychiatry and early career psychiatrists.

Abstract Psychiatry as a discipline will undergo major changes in the coming years. Although changes can be particularly stimulating and challenging from an intellectual, scientific and social viewpoint, the new generations of psychiatrists must be prepared to face these changes and deal with them appropriately. Paradigms which have represented the foundations of psychiatry in the last century now need a major revision. In particular, both trainees in psychiatry and early career psychiatrists need to (1) (re)discover psychopathology, (2) improve mental healthcare through integrated treatments, (3) identify and treat new syndromes, (4) promote an image of psychiatry with patients at the heart of care and as advocates for each other by fighting stigma and promoting the recruitment in psychiatry by medical students. These can be achieved by increasing involvement in institutions and organizations to influence the agenda. In this paper the possible contribution of trainees and early career psychiatrists is discussed and recommendations are made in order to set a new agenda for early career psychiatrists who will still be practising 2–3 decades from now.

Metabolic syndrome in female patients with schizophrenia treated with second generation antipsychotics: a 3-month follow-up.

The objective of this study was to determine the occurrence of metabolic abnormalities among previously unmedicated female patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition schizophrenia spectrum disorders and their associations with olanzapine and risperidone treatment. We analysed 94 female patients who were treated with olanzapine or risperidone in the period of 3 months. Analysed variables included fasting glucose, total cholesterol, low-density lipoprotein (LDL), high-density lipoproteins and triglycerides in blood, blood pressure (BP), waist and hip circumferences and body mass index (BMI). At baseline, 14 patients (15%) fulfilled criteria for metabolic syndrome. After 3 months of treatment, 25 patients (27%) fulfilled criteria for metabolic syndrome, and their baseline BMI was the only predictor for its development. Treatment with both antipsychotics was associated with significant increase in waist circumference. Positive family history of diabetes mellitus contributed to a significant greater increase in abdominal obesity, significant higher baseline levels and a borderline significant increase in fasting glucose among olanzapine-treated patients. Olanzapine admission was associated with a significant increase in LDL and risperidone with a significant increase in triglycerides. Metabolic abnormalities seem to be more prevalent in unmedicated female patients with schizophrenia spectrum disorders than expected based on results in general population (adjusted for age and sex). Olanzapine treatment might induce significant alterations in metabolic profiles, especially among patients with positive family history of diabetes, mostly by inducing abdominal obesity. The association of risperidone application and increase in triglyceride level still needs to be determined.

Development of the PICMIN (picture of mental illness in newspapers): instrument to assess mental illness stigma in print media

PurposeThe aim of this paper is to report on the development and applicability of a standardised and objective measure of stigma of mental illness in print media. Picture of mental illness in newspapers (PICMIN) instrument consists of eleven descriptive and five analytical categories. It is intended to allow comparison among countries and different studies over time.MethodsThe research team conducted a three-phase study to develop the instrument based on the principles of content analysis and test its inter-coder reliability (ICR). In the first phase, keyword search and ICR assessment was performed on articles from Croatia (75), Czech Republic (203), and Slovakia (172). The second phase consisted of instrument revision and training, along with ICR reassessment on 40 articles from USA and UK. In the third, main phase articles from Croatia (238), Czech Republic (226), and Slovakia (158) were analysed with the final version of the PICMIN instrument.ResultsAcross three countries, ICR was found acceptable to assess mental illness representations related to stigma in print media. Print media representations of the mental illness in Croatia, Czech Republic, and Slovakia significantly differed in the type of media distribution, whether headline of the article was positioned on the media cover, in the use of a sensationalistic style of writing, in the association of aggressive behaviour with persons with mental illness and in the distribution of the global impression of the headline.ConclusionsPICMIN instrument allows comparison among countries and different studies over time.

EPA-1103 - Personality across the aggressive spectrum - a cross-sectional study of 358 males with paranoid schizophrenia

Introduction Aggressiveness is one of the most stigmatization symptoms of paranoid schizophrenia with its possible roots in personality and/or acute psychopathology of schizophrenia. Objectives To explore general and personality differences among suicidal, homicidal and non-aggressive male subjects with paranoid schizophrenia. Methods We recruited all consecutive inpatients fulfilling the ICD-10 criteria of paranoid schizophrenia during 2009-2011. Personality traits were determined by the NEO Five-Factor Inventory (NEO-FFI) scale which measures the five major personality traits: emotional stability, extraversion, openness to experience, agreeableness and conscientiousness). Results The study included 359 male subjects diagnosed with paranoid schizophrenia. Their mean age was 37,8 yrs (SD 11,9) and duration of illness 13,77 yrs (SD 12,1). Majority were single (N=271, 75,5%), with 8-12 yrs of education (N=266, 75%) and unemployed (N=193, 53,8%). In an attempt to assess their auto and heteroagressivness, subjects were divided into three groups: subjects with suicide ideation (N=66, 18.4%), subjects with suicide attempt (N=67, 18,7%) and subjects with homicidal behavior (N= 86, 24%). These groups were compared against the comparative group of subjects without suicidal ideation, suicide or homicide behavior (N=140, 39%). Subjects with homicide behavior were significantly older, with longer duration of illness, majority were diagnosed with comorbid alcohol addiction and these participants scored higher on the emotional stability subscale (ANOVA F=7.8, df= 3, P=0.001). Conclusion These findings might contribute to discussion of the role of personality characteristics in paranoid schizophrenia.

Are there future psychiatrists among medical students in Croatia? The role of premedical and medical factors on career choice in psychiatry

Abstract Despite the high prevalence of mental disorders, a worldwide shortage of psychiatrists exists. Moreover, the number of students interested in choosing psychiatry as their future profession is low and psychiatry is frequently regarded as one of the least wanted medical specializations. We report the findings of a cross-sectional quantitative survey of final year Croatian medical students as part of the International Survey of Student Career Choice in Psychiatry (ISoSCCiP). The questionnaire consisted of three sections: socio-demographic factors, psychiatric education during medical school, and attitudes and personality characteristics. Out of 200 students, 122 completed the questionnaire (response rate 61%). The overall student evaluation of the compulsory psychiatry curriculum was ‘average’. Significantly higher ratings were reported by students who attended special psychiatry teaching modules, or felt more involved in the teaching of the subject. Poor evaluation of medical school psychiatric education significantly increased the likelihood of not choosing psychiatry as a future career. The choice of psychiatry was also predicted by attitudes towards psychiatry and by personal characteristics. In conclusion, student ratings of medical school psychiatric education and involvement in teaching appear to influence choice towards psychiatry. Addressing these issues may increase the number of students motivated to pursue psychiatry as their future career choice.

ECP03-02 - Mental health of european psychiatry trainees - results from the boss study

Psychiatrists of today are expected to be experts in prevention, diagnostics and treatments of mental illness; understand human genome and pharmacogentics, integrate it with psychotherapy and sociotherapy; and have great management and communication skills that would facilitate all previously listed. Crucial period to gain “superpowers” are residency training and early-career years. Even though choices made during this period can have long lasting consequences and strongly define ones professional pathway, majority of training programs worldwide does not include consultations or supervisions that would enable people to choose what best fits their personality and professional capacity. This can have significant implications on clinical performance and patient care, academic performance (in terms of research and publications), but also mental health and well being of residents are early career psychiatrists. The latter probably needs additional consideration since our study on this topic (The International Psychiatry Residents/Trainee Burnout Syndrome study) shows that European psychiatry residents suffer from moderate level of burnout syndrome, 5% meet criteria for major depression, 1% attempted suicide, while the number of those with serious suicidal ideation goes up to 20% in some countries. Our aim is to increase awareness of this issue and discuss prevention and treatment strategies.

PW01-203 - Predictors of stigmatizing and destigmatizing articles on mental illness in the printed media: a central European perspective

Objectives Many studies describing print media representations of mental illnesses have showed that these depictions are frequently negative and contribute to consequent stigmatization of people with mental illness. The main objective of this international study was to identify predictors of stigmatizing and nonstigmatizing articles on mental illness in Czech Republic, Croatia and Slovakia. Methods The study sample comprised all articles pertaining to the topic of mental illness (N=450) chosen from 6 most widely read newspapers and magazines identified during five weeklong periods in 2007. The presence of stigmatization and destigmatization statements was coded and articles were grouped in positive, neutral, mixed and negative clusters. Negative/positive ratio (NPR) was used to assess the predictor value of different features of the article regarding stigmatization. Results 61.8% of articles contained some stigmatizing statements towards persons with mental illness. The highest NPR was found in articles published in tabloids (6.8), on the front page (3.7) and in the articles where psychotic disorder was mentioned (7.4) and mentally ill person figured as a source of information (1.8). Lowest NPR was found in magazines (0.6), articles in later sections (1.7) that mentioned eating disorders (0.3) and scientific surveys (0.1). Conclusions There is a high level of stigmatizing statements in the studied articles. As the strongest predictors of stigmatizing content we have identified articles that are published in tabloids and articles with reference to psychosis. Contrary to this, eating disorders had the least stigmatizing depiction as well as articles containing scientific data.