Indications for psychiatric safety measures: a retrospective study.

The aim of this article has been designed to investigate the influence of particular diagnostic categories on recommendations for safety measures, and to investigate the impact of constellatory factors, as the states of acute alcoholism, acute intoxication by psychoactive drugs and intense affect, on the recommendations for safety measures. The sample consisted of 120 examinees forensically expertised at the Center for Forensic Psychiatry of the Psychiatric Hospital Vrapce in the period from January 1, 1998 to December 31, 1999, and evaluated as less responsible according to the new Penal Code. All the examinees had the same legal presumptions for safety measures (decreased responsibility). The sample was divided into two groups: a group of examinees for whom a safety measure had been recommended and a group without such recommendations. The basic methodological instrument was a specially designed questionnaire with 137 items. Regarding socio-demographic characteristics, no statistically significant differences existed between the two groups taking into account age, gender, level of education and marital status. The diagnosis of personality disorder as the first one, did not influence recommendations for safety measures. Alcohol and drug abuse were statistically significantly present in the group with recommended measures as second diagnoses, and besides influencing responsibility, had an impact on the recommendation of safety measures. An intense affect influenced the reduction of responsibility, but not the suggestion of safety measure, while alcohol and drug intoxications, besides affecting responsibility, had an impact on the suggestion of safety measure. The decisive impact of dependence influenced the recommendation for safety measures.

Abnormal systolic blood pressure during treadmill test and brachial artery flow-mediated vasodilatation impairment.

The aim of the study was to assess the relationship between systolic blood pressure during maximal treadmill test (SBP9mtt)) and flow-mediated vasodilation (FMD). Abnormal rise of SBP(mtt) is the phenomenon more frequent in hypertensive persons but it could be found in normotensive subjects too. 199 subjects referred to treadmill test were enrolled in the study. Four groups were formed: hypertensives with abnormal SBP(mtt) (group A), hypertensives with normal SBP(mtt) (group B), normotensives with abnormal SBP(mtt) (group C) and normotensives with normal SBP(mtt) (group D). Rise of SBP(mtt) above 200 mmHg was considered abnormal reaction. Simple linear regression analysis showed significant inverse relationship between SBP(mtt) and FMD (F = 20.2036, p < 0.001, R2 = 0.0956). Mean FMD index was worst in hypertensive subjects with abnormal SBP(mtt) (group A), followed by normotensives with abnormal SBP(mtt) (group C), hypertensives with normal SBP(mtt) (group B) and the best was in normotensives with normal SBP(mtt) (3.56 +/- 5.17, 4.19 +/- 5.14, 6.81 +/- 8.43 and 10.92 +/- 7.48%, respectively). In multivariate regression analysis FMD showed significant association with abnormal SBP(mtt) (p < 0.001) along with brachial artery diameter (p < 0.001), male gender (p < 0.001), but not with hypertension (p = 0.073), BMI (p = 0.137) and total cholesterol (p = 0.23) (coefficients: -0.26, -0.40, -0.27, -0.13, -0.11 and -0.07, respectively). There was a significant inverse relationship between SBP(mtt) and FMD. An impairment of FMD exists in normotensive subjects with abnormal SBP(mtt). In hypertensives with abnormal SBP(mtt) an additional impairment of FMD exists when compared to hypertensives with normal SBP(mtt). Abnormal SBP(mtt) should be taken into account in global cardiovascular risk assessment.

[Introducing computer units into the reception office as part of the Vrapce Psychiatric Hospital Information System]. / Informatizacija prijamne ambulante kao segment Informacijskog Sustava Psihijatrijske Bolnice Vrapce.

Computerized medical record has become a necessity today, because of both the amount of present-day medical data and the need of better handling and processing them. In more than 120 years of the Vrapce Psychiatric Hospital existence, the most important changes in the working concept of the reception office took place when computer technology was introduced into the routine use. The reception office of the Hospital is the vital place where administrative activities intersect with medical care for a patient presenting to the Hospital. The importance of this segment of the Hospital is emphasized by the fact that the reception office is in function and at patients' disposition round-the-clock, for 365 days a year, with great frequency of patients. The shift from the established way of registering medical data on patient admission in handwriting or, later, typescript, to computer recording was a challenging and demanding task (from the aspects of hardware, software, network, education) for the development team as well as for the physicians because it has changed the concept (logic of the working process) of previous way of collecting the data from the patient (history, status, diagnostic procedures, therapy, etc.). The success in the development and implementation of this project and the confirmation of its usefulness during the four-year practice at Vrapce Psychiatric Hospital are best illustrated by the fact that other psychiatric hospitals in Croatia have already introduced or are introducing it in their daily practice.

Implementation of first Croatian Law on Protection of Persons with Mental Disorders.

The aim of this article was to examine Croatian psychiatric practice regarding involuntary hospitalization, after the Law on Protection of Persons with Mental Disorders became effective, on January 1, 1998. Data on the practice of involuntary hospitalizations of patients with mental disorders in Vrapce Psychiatric Hospital were collected from the medical records, for the years 1998 and 1999. Data regarding involuntary hospitalizations from other Croatian hospitals and departments were obtained from heads of psychiatric hospitals and departments for the first five months of 1998. The rate of involuntarily hospitalized patients in Vrapce Psychiatric Hospital rose significantly from 1998 to 1999 (p < 0.01). The rate of patients involuntarily hospitalized under section 21, subsection 3 rose significantly from 1998 to 1999 (p < 0.01), while rate of patients involuntarily hospitalized under section 22, subsection 1 decreased significantly in the same period (p < 0.01) in Vrapce Psychiatric Hospital. The implementation of the Law on protection of persons with mental disorders was not applied uniformly in all Croatian psychiatric institutions during first five months of 1998. Further analyses on this subject are necessary in order to investigate the influence of changes and supplements to the Law on the protection of persons with mental disorders on the practice of involuntary hospitalizations.

The impact of novel antipsychotic drugs on quality of life among people suffering from schizophrenia.

More attention is increasingly being paid to quality of life of people suffering from schizophrenia. The results of numerous clinical trials indicate that novel antipsychotic drugs are as efficient (if not more so) than the conventional drugs. Novel drugs also cause fewer side effects and allow for better quality of life. In order to confirm these thesis we have studied the quality of life of 80 female outpatients in good social remission that have been under psychiatric evaluation for at least six months and were on antipsychotic drugs. Of those 80 outpatients, half were on the conventional medication, while the other half were on the novel antipsychotic drugs. Their life quality was evaluated with the questionnaire "Heinrichs-Hanlon-Carpenter--Quality of life questionnaire", which is one of the most frequently used QL scales. The results demonstrate that the only difference between the two groups lies in the field of social activity. While leaving the question of different influence of novel and conventional drugs open, the authors are trying to find the possible reasons for such results.