From Selye's and Szabo's Cysteamine-Duodenal Ulcer in Rats to Dopamine in the Stomach: Therapy Significance and Possibilities.

We reviewed gastric ulcer healing by dopamine considering several distinctive duodenal key points. Selye and Szabo describe the cysteamine-induced duodenal ulcer in rats as a duodenal stress ulcer in patients. Szabo's cysteamine duodenal ulcer as the dopamine duodenal healing and cysteamine as a dopamine antagonist signifies the dopamine agonists anti-ulcer effect and dopamine antagonists ulcerogenic effect. From these viewpoints, we focused on dopamine and gastric ulcer healing. We mentioned antecedent studies on the dopamine presence in the stomach and gastric juice. Then we reviewed, in the timeline, therapy significance arising from the anti-ulcer potency of the various dopamine agonists, which is highly prevailing over the quite persistent beneficial evidence arising from the various dopamine antagonists. Meanwhile, the beneficial effects of several peptides (i.e., amylin, cholecystokinin, leptin, and stable gastric pentadecapeptide BPC 157, suggested as an acting mediator of the dopamine brain-gut axis) were included in the dopamine gastric ulcer story. We attempt to resolve dopamine agonists/antagonists issue with the dopamine significance in the stress (cysteamine as a prototype of the duodenal stress ulcer), and cytoprotection (cysteamine in small dose as a prototype of the cytoprotective agents; cysteamine duodenal ulcer in gastrectomized rats). Thereby, along with dopamine agonists' beneficial effects, in special circumstances, dopamine antagonists having their own ulcerogenic effect may act as "mild stress (or)" or "small irritant" counteracting subsequent strong alcohol or stress procedure-induced severe lesions in this particular tissue. Finally, in the conclusion, as a new improvement in further therapy, we emphasized the advantages of the dopamine agents' application in lower gastrointestinal tract therapy.

Pathological narcissism and depressive symptoms in psychiatric outpatients: mediating role of dysfunctional attitudes.

OBJECTIVE: The aim of this study was to examine the relationships between pathological narcissism (narcissistic grandiosity and narcissistic vulnerability), dysfunctional attitudes (perfectionism and dependency on other people), and depressive symptoms in psychiatric outpatients. METHOD: A sample of 234 adult psychiatric outpatients (57.3% male; mean age 44.39 years) completed the Pathological Narcissism Inventory, the Dysfunctional Attitudes Scale-Form A, and the Depression, Anxiety, Stress Scales-21. RESULTS: Narcissistic vulnerability exhibited unique positive correlations with depressive symptoms, whereas narcissistic grandiosity showed substantially weaker correlations with depressive symptoms. Perfectionism partially mediated the relationship between narcissistic vulnerability and depressive symptoms. The mediating role of dependency was not confirmed. CONCLUSIONS: Among adult psychiatric outpatients, narcissistic vulnerability is more strongly related to depressive symptoms than narcissistic grandiosity, and dysfunctional perfectionism represents one of the underlying mechanisms of this relationship. The implications of these findings are discussed in relation to the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria and the treatment of pathological narcissism.

Mentalization and psychopharmacotherapy in patients with personality and eating disorders.

Contemporary psychiatry pays more and more attention to the patient's capacity regarding acceptance of psychiatric drugs. Understanding the basis of our treatment's effectiveness becomes more challenging. To understand psychiatric treatment psychiatrists must pay full attention to mentalizing and the conditions under which this basic human capacity becomes impaired especially in those suffering from personality and eating disorders. This paper discusses the meaning and clinical applications of the mentalizing related to psychopharmacotherapy for personality and eating disorders patients, including suicidality.

Relationship between psychopathological factors and metabolic control in children and adolescents with insulin-dependent diabetes mellitus.

This paper provides a critical overview of the literature on the relationship between psychological/psychopathological factors and metabolic control in children and adolescents with insulin dependent diabetes mellitus (IDDM). We discuss studies on individual and family psychopathological factors, as well as reports on the effects of psychoeducational/psychotherapeutic interventions on glycemic control in patients with IDDM aged <18 years. The analysis of the literature indicates that while evidence on the relationship between individual factors and metabolic control is still mixed, in part due to methodological issues, results from family studies do suggest that patients in dysfunctional families and children of parents with high degrees of psychopathology present with poor glycemic control. As for the effects of psychoeducational/psychotherapeutic interventions, limited but increasing evidence shows that they can actually contribute to improve metabolic control. We finally suggest some future underexplored avenues of research in the field, including studies on the psychopathological and neurobiological mechanisms underlying the above mentioned findings. All this body of research should provide a strong empirical rationale for allocating resources in order to include psychiatrists within the interdisciplinary diabetes health care team.

Premorbid combat related ptsd in Huntington's disease - Case report.

Huntington's disease (HD) is a neurodegenerative, autosomal dominant disease that manifests with a triad of symptom clusters including movement disorder, cognitive impairment and psychiatric symptoms. We present a patient with HD who, prior to developing neurological signs and symptoms, had been exposed to war trauma and had developed posttraumatic stress disorder. Fifteen years later he manifested with dysarthria, difficulties with swallowing and involuntary movement. What brought him to psychiatrist was a heteroanamnestically noticed change in personality with irritable mood, impulsivity, aggressive outbursts in behavior and delusional ideation. Therapy was stared with haloperidol, but patient developed severe extrapiramidal side effects. Subsequent treatment with olanzapine, diazepam and omega 3 fatty acids lead to mood stabilization and better impulse control with even some improvement in motoric symptoms. To our knowledge, this is the first case report on combat related PTSD as psychiatric disorder manifested prior to HD. We discuss a possible influence of psychological stress disorder on severity of psychiatric symptoms in the HD. The importance of personalized approach in both psychopharmacological and psychotherapeutical treatment of patients with HD is emphasized. If the influence of environmental stress on the psychiatric phenotype of the disease should be confirmed by clinical trials and further studies, both screening methods and interventions aimed to reduce psychological stress in carriers of Huntington gene could be considered.

Relationship among psychopathological dimensions, coping mechanisms, and glycemic control in a Croatian sample of adolescents with diabetes mellitus type 1.

Psychopathological factors associated with metabolic control in juvenile insulin-dependent diabetes mellitus (IDDM) deserve further investigation. This study assessed the relationship among specific psychopathological dimensions, coping mechanisms, and metabolic control in a Croatian clinical sample of adolescents with IDDM. One-hundred and one adolescents (aged 11-18) with IDDM filled out the youth self report (YSR) assessing psychopathological dimension and the scale of coping with stress (SCS). Glycemic control was estimated by the percentage of glycated hemoglobin (HbA1c). Subjects were divided into three groups according to HbA1C values: "optimal", "suboptimal control", and "at high risk". Subjects in optimal glycemic control presented with significantly lower scores in most of YSR scales compared to subjects at high risk. Moreover, they had significantly lower scores in avoidance and emotional reactivity and significantly higher scores in cognitive restructuring and problem solving SCS subscales. Regression models revealed that both internalizing and externalizing YSR scores, as well as emotional reactivity coping scores, independently contributed to explain variability of HbA1C values. Both internalizing and externalizing psychopathological dimensions, as well as emotion-oriented coping strategies, are independently associated with poor metabolic control in both boys and girls with IDDM, thus representing potential interest targets of psychotherapeutic interventions aimed at improving glycemic control in this population.

Problems in the current psychiatry residency training program in Croatia: residents' perspective.

The aim of this study is to evaluate the quality of the current residency training in psychiatry in Croatia using parameters of professional achievements of residents and their subjective evaluations of the residency training that is being offered. 66 residents from 15 Croatian psychiatric hospitals, clinics and wards in general hospitals fulfilled the questionnaire constructed to obtain information about the profile of psychiatry residents in Croatia, parameters of educational quality and evaluation of offered residency training as seen by residents. We interviewed 89% of all residents that had a trainee status in September and October 2006 in Croatia (66 out of 74). Study results indicate that Croatian psychiatry residents are derived from a pool of very good medical students and the majority is engaged in postgraduate studies and research activities and shows high interest in specific psychiatric fields such as psychotherapy and clinical psychiatry. Most of participants are only partially satisfied with the residency training that is being offered and feel that most problems reside from the lack of practical psychotherapy, the inefficiency of the mentorship system and the lack of funding resources. The results of this study revealed the major problems of psychiatry residents in Croatia. Following those results, we will perform the study that would include mentors and supervisors from different Croatian psychiatric centers. That could enable the development of specific interventions with aim to improve current residency training in Croatia.

Towards an integration of psychoanalysis and neurobiology in 21st century.

The "inner world" of the mind was, in the past, the traditional preserve of psychoanalysis and related disciplines, and it was therefore placed at the margins of neural science. During 1990-ies numerous investigations in the field of neuroscience have led to significant findings, which explain biological correlates ofpsychological functions. There are much scientific evidence that support association between psychoanalysis and neuroscience. Psychoanalysis offers a unique in-depth perspective on the psychology of human motivation, and furthermore has contributions both to make and to receive in the gathering scientific integration.

Countertransference in the therapy of suicidal patients - an important part of integrative treatment.

One of the central issues in the psychotherapy of suicidal patients is the countertransference. Key concepts in countertransference include projective identification, role-responsiveness and countertransference enactment. It is important to recognize that countertransference can be effective in understanding the emotional intensity of the suicidal person's internal world. There is a significant relationship between treatment outcome and the different countertransference feelings among the therapists. In this paper we have illustrated important factors for understanding psychiatrist's countertransference reactions when working with suicidal patients.

The Child Behavior Checklist, Teacher Report Form and Youth Self Report problem scales in a normative sample of Croatian children and adolescents aged 7-18.

The main goal of this study was to standardize the Child Behavior Checklist (CBCL), Teacher Report Form (TRF) and Youth Self Report (YSR) questionnaire problem scales on a normative random sample of children and adolescents (N=3309) aged 7 to 18 throughout Croatia. The second goal was to compare boys-girls problem scales data and CBCL-TRF-YSR differences in our sample. The mean value of CBCL scores for the Total Problems scale for different groups (children/adolescents; boys/girls) ranged from 17.07 to 20.71. Overall instruments' internal consistency ranged from 0.83 to 0.86. In almost all the scales parents reported higher scores than teachers (p < 0.01). In all the scales adolescents reported significantly higher scores than their parents and teachers (p < 0.01). This study standardized the questionnaires for our specific socio-cultural circle, which satisfy complex psychopathology study criteria. Problem scales results in our sample suggest similarity to previous European researches.

Comparison of self-reported and parent-reported emotional and behavioral problems in adolescents from Croatia.

The first goal of this study was to obtain, Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) problem-scales data for youths in Croatia, and compare them to the original American sample. The second goal of this study was to compare boys -girls problem scales data and CBCL-YSR differences. The instruments were administered to school adolescents aged between 12-18 comprising a non-referred sample (n=611) drawn from the whole country. Youths, compared to their parents, rated higher scores in all scales in both sexes (p < 0.001). According to parents' reports boys had higher scores in more scales (five out of eleven). According to adolescents'self-reports girls had higher scores in more scales (seven out of eleven). Consistent with other studies, Croatian sample confirmed a larger number of serious behavioral and emotional problems reported by adolescents. Adolescents were confirmed as the most reliable informants on their problems.