The effect of vortioxetine on anhedonia in patients with schizophrenia.

OBJECTIVE: Anhedonia is a common symptom of depression, but is also a negative symptom of schizophrenia. The purpose of this study was to examine the effects of vortioxetine on anhedonia in patients with schizophrenia. METHODS: A total of 120 patients with schizophrenia in remission who met inclusion criteria were randomized 1:1 by the envelope method into intervention and control groups. All participants in both groups were divided into three subgroups based on the antipsychotic therapy they were receiving (olanzapine, risperidone, or aripiprazole). Vortioxetine was administered to those in the intervention group at a fixed dose of 10 mg per day. The Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), and Chapman Scale for Social and Physical Anhedonia (CSPA) were administered. The study lasted 12 weeks. Participants were assessed twice: At baseline and at the end of the study. Six participants dropped out, with 114 completing the trial. FINDINGS: Vortioxetine treatment had a significant effect on level of physical anhedonia. The treatment interaction was also statistically significant, but with a relatively small effect (F = 3.17, P < .05; η2 = .061). Vortioxetine treatment had a particularly strong effect on the level of social anhedonia. The interaction between the treatment and the type of antipsychotics was also statistically significant with a small effect (F = 5.04, P < 0. 01; η2 = .091). CONCLUSION: The combination of olanzapine and vortioxetine was found to be the best option to reduce symptoms of social and physical anhedonia in these patients with remitted schizophrenia.

Escape from reality or practicing life in the virtual world.

The modern technology contributes to the development of more complex video games, in which the participant can be completely immersed in the game and have the experience of his own presence in the virtual world through his avatar, which assumes the characteristics of the player. A wide range of motives can mediate pleasure in the virtual world. The virtual world provides the illusion of reality. It makes possible to bypass the need for mental processing of connections and transformations that forms a bridge between the inner world of fantasy and objective reality. It is considered that video games shift the focus to control and narcissistic gratification and that communication in virtual reality implies a greater cathexis of skills and performance than emotions and thoughts. Can we understand video games as a type of projective technique? Strategic video games are often among the one of most popular video games. The authors collected data and materials on the mentioned topics from their daily clinical work, and present a case report. Observing video games through virtual spaces and the ways in which young players use them, we can conclude, that they have the capacity to be useful for various aspects of young people's development, but they can also interfere with it.

The relationship among psychopathology, religiosity, and nicotine dependence in Croatian war veterans with posttraumatic stress disorder.

AIM: To examine relationships among combat exposure, posttraumatic stress disorder (PTSD) symptoms, depression, suicidality, nicotine dependence, and religiosity in Croatian veterans. METHODS: This cross-sectional study used Combat Exposure Scale (CES) to quantify the stressor severity, PTSD Checklist 5 (PCL) to quantify PTSD severity, Duke University Religion Index to quantify religiosity, Montgomery Asberg (MADRS) and Hamilton Depression (HAM-D) rating scales to measure depression/suicidality, and Fagerstrom Test for Nicotine Dependence to assess nicotine dependence. Zero-order correlations, cluster analysis, multivariate regression, and mediation models were used for data analysis. RESULTS: Of 69 patients included, 71% met "high religiosity" criteria and 29% had moderate/high nicotine dependence. PTSD was severe (median PCL 71), depression was mild/moderate (median MADRS 19, HAM-D 14), while suicidality was mild. A subset of patients was identified with more severe PTSD/depression/suicidality and nicotine dependence (all P<0.001). Two "chains" of direct and indirect independent associations were detected. Higher CES was associated with higher level of re-experiencing and, through re-experiencing, with higher negativity and hyperarousal. It also showed "downstream" division into two arms, one including a direct and indirect association with higher depression and lower probability of high religiosity, and the other including associations with higher suicidality and lower probability of high nicotine dependence. CONCLUSIONS: Psychopathology, religiosity, and nicotine dependence are intertwined in a complex way not detectable by simple direct associations. Heavy smoking might be a marker of severe PTSD psychopathology, while spirituality might be targeted in attempts of its alleviation. Oxford Centre for Evidence-based Medicine level of evidence: 3.