Natural killer cell cytotoxicity and lymphocyte perforin expression in veterans with posttraumatic stress disorder.

OBJECTIVE: To examine the effect of posttraumatic stress disorder (PTSD) on the measures of immune function and the hypothalamic-pituitary-adrenal axis components, and to determine whether additional life stressors affect measured variables. METHODS: We simultaneously examined the natural killer cell cytotoxicity (NKCC), perforin and glucocorticoid receptor (GCR) expression in natural killer (NK) and cytotoxic T (CD8) cells, as well as serum cortisol concentration in a group of Croatian war veterans with chronic, combat-related PTSD (n=29) and a group of healthy, age-matched men (n=13). PTSD patients were divided into two subgroups: compensation-seeking (n=15) and retired or compensation non-seeking (n=14) subjects. The former includes those involved in the process of getting disability-based army retirement as an additional life stressor. RESULTS: NKCC was decreased in both PTSD groups when compared to controls. Impairment of NKCC could not be attributed to the perforin expression as perforin was not decreased in comparison to controls. Moreover, the increased level of perforin was recorded in NK cells of retired PTSD subjects. Both PTSD groups shared an increased relative quantity of GCR in lymphocytes, whereas no difference between the groups in the baseline levels of serum cortisol was observed. CONCLUSIONS: Diminished NKCC was not accompanied by perforin insufficiency in PTSD subjects, and other causes should be examined. An additional life stressor does not contribute considerably to either immune or endocrine system related changes.

Update of suicide trends in croatia 1966-2002.

OBJECTIVE: To analyze trend the suicide rates in Croatia during the pre-war period of socialistic Yugoslavia (1966-1990), war period in the former Yugoslavia (1991-1995) and the post-war period of Croatian independence and democratization (1996-2002). METHOD: Using official suicide statistics, this study examined suicide rates in Croatia over a 36-year span (1966 to 2002) as a function of gender, age, marital status, time, war and social changes. Suicide rates were displayed graphically and compared with some neighbouring countries (Slovenia, SCG, Hungary and Italy). RESULTS: During the period of socialistic Yugoslavia, suicide rate in Croatia was constantly increasing with small variations. During the war time suicides with firearms were significantly increased. Since 1993 (the period of independence and democratization) there has been a trend of evident decrease in total suicide rate. CONCLUSION: This study demonstrated that Croatia has still had high suicide rates with declining trend since 1993, probably related to democratization, more national, religious and cultural rights, better availability of SSRIs and systemic campaign for education of general practitioners for early recognition and treatment of depressive disorders.

Alterations in brain activation in posttraumatic stress disorder patients with severe hyperarousal symptoms and impulsive aggressiveness.

OBJECTIVE: We wanted to assess possible alterations in brain activation in PTSD patients with severe hyperarousal symptoms and impulsive aggressiveness. METHOD: 25 Croatian War (1991-1995) veterans with combat-related PTSD with severe hyperarousal symptoms and impulsive aggressiveness were assessed for possible alterations in cerebral blood flow in single photon emission computed tomography brain scans. RESULTS: Increased regional cerebral blood flow in projection area of nucleus accumbens was found in 13 of 25 subjects, and for all in the dominant brain hemisphere. DISCUSSION: We believe that at least some of PTSD symptoms, and especially the impulsive aggression, can be associated with increased regional cerebral blood flow in the projection area of nucleus accumbens.

Secondary victimization of war veterans with post-traumatic stress disorder: the croatian experience.

This paper discusses the phenomenon of secondary victimization or revictimization of Croatian war veterans with post-traumatic stress disorder (PTSD). This revictimization is mainly characterized by a disappointing institutional response from the helping professions, together with a lack of social recognition and support after the war. Also, we describe the "blaming the victim" process in which the veterans with PTSD were accused for bringing their maladies on themselves due to their premorbid psychological characteristics. This paper traces the origins of these phenomena in Croatia and compares them to other traumatized populations throughout the world, adding to the established body of knowledge which confirms that denial of PTSD in war veterans is a widespread social occurrence which spans over history, crossing national and cultural boundaries.

[Diagnostic and therapeutic guidelines for posttraumatic stress disorders]. / Dijagnosticke i terapijske smjernice za posttraumatski stresni poremecaj.

Posttraumatic stress disorder (PTSD) presents an important medical and social problem in the Republic of Croatia with prevalence of 10-30% depending on the population. On the basis of our 8-year clinical experience in treating PTSD and detailed analysis of related literature a special team of the Department of Psychological Medicine, Zagreb University Hospital, compiled the proposed guidelines for diagnostics and treatment of PTSD. The established guidelines are independently developed, clinically proven at our Clinic and in terms of custom made procedure world wide unique. Their essential feature is psychoanalytic comprehension and approach to etiopathogenesis of PTSD, although it also applies to other psychotherapeutic techniques (cognitive-behavioral, relaxation, existential). The diagnostic model is based upon structured clinical interview (DSM-IV, ICD-10), but it also complies with the principles of psychotherapeutic interview. Therapeutic interventions as proposed are divided according to therapeutic goal into symptomatic and etiological.