Paola Medved

P01-23 - Compliance with treatment - a prerequisite for diagnosing and treatment efficacy

Aim Lack of patient compliance in a general psychiatric ambulatory causes delays in diagnosing as well as in patient treatment efficacy. Method a 30 year old patient underwent a psychiatric treatment which lasted two yaers. He was treated with a combination of psychopharmacs and psychotheraphy. Results The patient contacted a psychiatrist for the first time exhibiting the following symptoms: loss of will and interests, weight gain, lowered general mood, avoidance of social contacts. A depressive episode was diagnosed and and antidepressive was introduced to his therapy (fluvoxamine). He did not comply to the therapy assigned nor he attended his scheduled examination. His medicamentous therapy was intensified (fluoxamine, alprazolam, promazine). After six months, the patient returned in company with his family, and his non-compliance with the therapy was revealed. After a sucessfful therapy an improvement in his mental state was noticed. During the last year, he was regular at his examinations and medication, with psychotherapy once a week. Conclusion Patient compliance is a prerequisite for diagnosing and a successful treatment. Combined treatment methods (psychopharmacotherapy, psychotherapy) with an adherend patient guarantee a good remission.

52 Forensic dilemmas: antisocial personality disorder –mentally disturbed or normal?

Osobe sa poremecajem licnosti sve su cesce u psihijatrijskoj praksi. Osobe sa antisocijalnim poremecajem licnosti, cesto su u sukobu sa zakonom, i predmet su forenzicne psihijatrije. Njihov model ponasanja i funkcioniranja nerijetko postane stil života. Prepoznavanje ranih razvojnih znakova impulzivnosti i poremecaja u ponasanju je od sustinske važnosti u prevenciji kriminala jer je to kombinacija koja rezultira najgorim mogucim prognostickim ishodom: trajnom psiholoski strukturiranom predispozicijom za vrsenje krivicnih djela - antisocijalnim poremecajem licnosti, odnosno kriminalnom psihopatijom. Terminologija se mijenjala, ovisno od profesionalne orijentacije i vremena (psihopat, sociopat), a otkako je asocijalno ponasanje uslo u klinicku psihologiju i psihijatriju kao poseban entitet, nestalo je kriminalaca ; svi su postali bolesnici. Jesu li svi oni psihicki poremeceni ili ima kriminalaca koji su psihicki „ normalni“ ljudi? Iako su kriteriji poremecaja jasno definirani klasifikacijama, psihodijagnosticki instrumenti u praksi potvrđuju poremecaj licnosti ali ne diferenciraju podtipove, pa su kvalitetna anamneza i iskustvo, od najveceg znacenja za postavljanje dijagnoze. U forenzickoj procjeni dijagnostika ima svoju važnost, ali nas ona ponekada može i zavesti. Procjena profila licnosti i psihickog statusa, u konkretnom vremenu kaznenog djela, temelj je kvalitetne procjene i dijagnostike. Psihicki poremecen ili normalan, lijecenje ili sankcija-razlike su velike. Prikaz slucaja iz forenzicke prakse: muskarac koji je pocinitelj brojnih kaznenih djela teske krađe, vjestacen je kombinirano (psihijatrijsko-psiholoski) u odvojenim sudskim predmetima. Iznijet cemo rezultate ekspertiza komparativno. Kljucne rijeci: antisocijalni poremecaj licnosti, forenzicka praksa