Slavica Djukic-Dejanovic

Development of an International Schedule for the Assessment and Staging of Care for Dementia

BACKGROUND A reliable and valid global staging scale has been lacking within dementia care. OBJECTIVE To develop an easy-to-use multi-dimensional clinical staging schedule for dementia. METHODS The schedule was developed through: i) Two series of focus groups (40 and 48 participants, respectively) in Denmark, France, Germany, Netherlands, Spain, Switzerland, and UK with a multi-disciplinary group of professionals working within dementia care, to assess the need for a dementia-staging tool and to obtain suggestions on its design and characteristics; ii) A pilot-study over three rounds to test inter-rater reliability of the newly developed schedule using written case histories, with five members of the projects steering committee and 27 of their colleagues from Netherlands, France, and Spain as participants; and iii) A field-study to test the schedules inter-rater reliability in clinical practice in France, Germany, Netherlands, Spain, Italy, Turkey, South Korea, Romania, and Serbia, which included 209 dementia patients and 217 of their caregivers as participants. RESULTS Focus group participants indicated a clear need for a culture-fair international dementia staging scale and reached consensus on face validity and content validity. Accordingly, the schedule has been composed of seven dimensions including behavioral, cognitive, physical, functional, social, and care aspects. Overall, the schedule showed adequate face validity, content validity, and inter-rater reliability; in the nine field-sites, intraclass correlation coefficients (ICCs; absolute agreement) for individual dimensions ranged between 0.38 and 1.0, with 84.4% of ICCs over 0.7. ICCs for total sum scores ranged between 0.89 and 0.99 in the nine field-sites. CONCLUSION The IDEAL schedule looks promising as tool for the clinical and social management of people with dementia globally, though further reliability and validity testing is needed.

Meta-analysis of the changes in correlations between depression instruments used in longitudinal studies.

BACKGROUND Correlations between instruments measuring the same construct reflect their concurrent validity. Little is known about changes in correlations between such instruments employed in studies with repeated assessment. The aim of this meta-analysis was to examine the changes in correlations between depression instruments in the course of longitudinal studies. METHODS A literature search was conducted using MEDLINE and PsycINFO for the period from 1960 to 2013. The total number of collected articles was 3723, of which 61 were included. Three meta-analyses were performed for the changes in correlations between each pair of the three depression scales: Hamilton Rating Scale for Depression (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI). The effect size in these meta-analyses was obtained by the z-transformation of correlation coefficients. RESULTS Correlations between depression scales increased over time in 52 studies. Significant changes in correlation coefficients were found for correlations between HAMD and BDI (p<0.001) and for correlations between HAMD and MADRS (p<0.001). An increase in correlations between the scales was associated with a decrease in depression scores and increase in their variability. LIMITATIONS Univariable and multivariable meta-regression models were not obtained in all three meta-analyses because of the lack of data. CONCLUSIONS A finding that correlations between depression instruments tended to increase over time has significant implications for assessment of the concurrent validity of these instruments. In longitudinal designs it is important to estimate correlations between depression scales over time because different thresholds for scale correlations indicate acceptable concurrent validity at different times.

In vivo methodology in behavioural pharmacology: Where are we now?

*Institute of Pharmacology, Clinical Pharmacology and Toxicology, Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; Psychiatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia; Clinic for Psychiatric Disorders “Dr Laza Lazarević”, Belgrade, Serbia

POSITIVE IMPACT OF PRESCRIBED PHYSICAL ACTIVITY ON SYMPTOMS OF SCHIZOPHRENIA: RANDOMIZED CLINICAL TRIAL

BACKGROUND The purpose of this study was to examine functional capacity of cardio-respiratory system in patients with schizophrenia, and to evaluate the effects of 12 weeks prescribed physical activity on aerobic capacity and symptoms of schizophrenia. SUBJECTS AND METHODS Study involved 80 hospitalized patients with any of the subtypes of schizophrenia (42 men, 38 women). They were divided into two groups: exercise and control group, both with 40 patients. Maximal aerobic capacity (VO2 max) as an indicator of cardiovascular fitness has been obtained by cardiopulmonary stress test on a treadmill. Twelve weeks program of prescribed physical activity (45 minutes, four times per week) was made for every patient individually. Patients in exercise group practiced in training zone between 65 and 75% of their maximum heart rate (HR). Target HR was controlled by Polar F4 monitors. Symptoms of schizophrenia were measured by using Positive and Negative Symptoms Scale (PANSS). RESULTS Before the exercise program was introduced, measured VO2 max was significantly lower in patients with schizophrenia, than the expected average value in matched healthy subjects (p<0.001). After twelve weeks, patients in exercise group showed a significant increase of VO2max (p=0.002), and significantly higher level of VO2max compared to the control group (p=0.000). Significant differences were also observed on PANSS general psychopathology subscale (p=0.007) and on PANSS total score (p=0.001). The pharmacotherapy and exercise had influence on PANSS general psychopathology (p=0.002) and PANSS total score (p=0.001). CONCLUSIONS Individuals with schizophrenia have lower levels of aerobic capacity compared to general population. Prescribed physical activity significantly improves aerobic capacity in people with schizophrenia and it is effective in amelioration of some psychiatric symptoms. Prescribed physical activity could be an effective adjunctive treatment for patients with schizophrenia, not only for prevention and treatment of comorbidities, but also having an impact on symptoms of schizophrenia.

Cardiovascular comorbidities in hospitalized psychiatric patients with diagnoses of schizophrenic and affective disorders

CORRESPONDENT KATARINA ĐOKIĆ PJEŠČIĆ Clinic for psychiatric disorders “Dr Laza Lazarević”, Belgrade, Serbia katarina.djokic.pjescic@gmail.com DOI:10.5937/pramed1602083D

The importance of early recognition and timely treatment of delirium in intensive care units

CORRESPONDENT IVANA STAŠEVIĆ KARLIČIĆ Clinic for psychiatric disorders “Dr Laza Lazarević”, Belgrade, Serbia ivanastasevic73@gmail.com doi:10.5937/pramed1604101S

Pharmacotherapeutical possibilities in mental disorders: Current status in Serbia

The new therapeutical approaches have direct implications on living in order to accomplish remission, stop further progression of illnesses or improve the quality of life. The life expectancy has been increased up to 10 years in the last 55 years, probably owing to the innovative drugs. The innovative drugs application in our everyday clinical practice should be analyzed, related to economical aspects and to the transitional status of a country, but also in the context of fears and misconceptions of therapists. The cost of therapy is not equal to the cost of prescribed drugs, however it also includes direct and indirect costs and medical and nonmedical burden. Countries in our region spend 4-7.3% of the total budget for antipsychotic drugs, while the costs in Serbia are about 1.5%. The new antipsychotics and the new formulations of the available antipsychotics in the treatment of schizophrenia are pharmacoeconomically justified. On the other side, the substance abuse needs other strategies, including new substitution treatments. In our country only methadone maintenance therapy is available. It is necessary to provide adequate legislation to improve the process of drug registration. In the European Union it takes from 0 to 400 days for a drug to be registered, but in Serbia the process last longerthan 3 years. Important laws approved in 2006 and 2009, are only a part of the destigmatiazation of patients with mental disorders. Treatment guidelines also help in resolving these issues. Taking all of the above into consideration, the treatment of mental disorders with innovative drugs is financially justified, but still unreachable for patients in Serbia. The voice of the professionals should be heard in these matters in order to provide the adequate treatment of people with mental health problems.