The Role of COVID-19-Associated Fear, Stress and Level of Social Support in Development of Suicidality in Patients Diagnosed with Affective and Stress-Induced Psychiatric Disorders during the COVID-19 Pandemic-A Comparative Analysis.

Only a few studies seem to address suicidality as an effect of the COVID-19 pandemic in persons previously affected by psychiatric disorders. The relationship between fear and stress caused by the COVID-19 pandemic and the level of social support and suicidality in patients diagnosed with affective and stress-induced psychiatric disorders prior to the onset of the COVID-19 pandemic were investigated. This study was observational and involved 100 participants. The examined period was from April 2020 to April 2022. The Fear of COVID-19 Scale (FCV-19S), the Oslo Social Support Scale 3 (OSSS-3) and general psychiatric interviews were used to obtain data. A statistically significant relationship between the impact of COVID-19-related distress on the occurrence of suicidality and the year of the pandemic χ2(2, N = 100) = 8.347, p = 0.015 was observed. No statistically significant correlation was found between suicidal behavior, stress intensity, fear and the score on the social support scale (p > 0.05). Fear related to the COVID-19 pandemic can only be seen as a contributor to suicidality. Overall, social support does not always act protectively. Previously stressful experiences such as wars, poverty and natural disasters seem to play a significant role in the resilience to each new public health crisis.

Lithium: A classic drug-Frequently discussed, but, sadly, seldom prescribed!

OBJECTIVE: Distinguished authors in the field have repeatedly alerted psychiatrists of the alarming trends in the treatment of bipolar disorders: decline of lithium use, paralleled by the increase of prescribing anticonvulsants and second-generation antipsychotic drugs. Research has been conducted in order to explore the factors that led to this development and to provide arguments for the need to reverse this trend. METHOD: This paper represents a narrative review of the literature containing retrieved research articles focusing on the efficacy of lithium. The papers included in this overview were published prior to June 2016; additional papers were identified by searching the reference lists of reviewed articles. Taking into account the amount of literature available, no search can be exhaustive; on the other hand, the studies consulted, all of which explore the effectiveness of various compounds, may have their own limitations as well. RESULTS: The evidence of the effectiveness of lithium in the treatment of acute mania, acute bipolar depression and the prevention of manic and depressive episodes is compelling. Lithium is the most effective augmentation agent in treatment-resistant depression. Its anti-suicidal effects are well established. The neuroprotective effects of lithium have been demonstrated in case-control studies and in population-based research. It has been established that starting lithium early in the course of the disorder reduces the rates of treatment non-response. CONCLUSIONS: Despite abundant evidence regarding the efficacy of lithium and its effectiveness in the treatment of bipolar disorders, its use is declining at the beginning of the 21st century. It is of paramount importance to keep reminding psychiatrists and educating physicians about the unique properties of lithium and about monitoring patients treated with lithium, since it has been suggested that lithium should once again become the first-line treatment for bipolar disorders.

VALPROATE, BIPOLAR DISORDER AND POLYCYSTIC OVARIAN SYNDROME.

INTRODUCTION: Polycystic ovarian syndrome is a syndrome of ovarian dysfunction with the principal features of hyperandrogenism and polycystic ovary morphology. A large number of studies conducted on this topic have suggested a possible role of anticonvulsants, particularly valproate, in the pathogenesis or risk factors associated with polycystic ovarian syndrome. Bipolar treatment guidelines from Canada and the United States of America recommend valproate as the first line strategy in the acute treatment of bipolar disorder. DISCUSSION: Most persons with bipolar disorder require maintenance treatment. Long-term administration of valproate in women with bipolar disorder or epilepsy is believed to result in the increased risk of hyperandrogenism, menstrual abnormalities and polycystic ovaries. Valproate may also increase the risk of infertility and other associated symptoms of polycystic ovarian syndrome. Therefore, particular caution is indicated in the use of valproate in women of reproductive age. CONCLUSION: The treatment of the female patients with bipolar disorder presents various challenges for the clinician. Every woman of reproductive age needs to know the risk and benefits of her pharmacologic treatment options. Bipolar disorder should be considered chronic disorder, whose development is largely affected by hormonal changes and reproductive cycle in women. These issues should be researched more thoroughly in order to opt for the most appropriate treatment in women with bipolar disorder.

Deep brain stimulation in psychiatry.

INTRODUCTION: Deep brain stimulation is a stereotactic neurosurgical method used in the treatment of Parkinson's disease and some other movement disorders. The application of deep brain stimulation in the treatment of certain psychiatric disorders has been intensively investigated taking into account the current knowledge of neurobiological basis of mood regulation, cognition, and behaviour. This paper has been aimed at presenting the available data on experience in the application of deep brain stimulation in the treatment of psychiatric disorders. It gives an overview of scientific and professional literature, bearing in mind all the contemporary approaches in the treatment of certain psychiatric disorders. Research results available so far in the treatment of treatment-resistant depression, obsessive-compulsive disorder, Gilles de la Tourette syndrome, addiction and Alzheimer's dementia, are affirmative concerning the efficacy of the method and low risk of adverse effects. Deep brain stimulation, as a relatively new neurosurgical method in the treatment of psychiatric disorders, is being intensively developed, and it is certainly going to be one of the treatments of choice, primarily of treatment-resistant disorders.

Extrapyramidal syndromes caused by antipsychotics.

INTRODUCTION: Extrapyramidal syndromes are significant side effects of antipsychotic therapy due to their severity, frequent occurrence and complications. This paper gives a brief summary of the literature with the emphasis on epidemiology, etiology, diagnosis and differential diagnosis, as well as the treatment of extrapyramidal disorders induced by antipsychotics. DYSTONIA: Sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It may appear either as an acute or delayed, i.e. tardive sign. The incidence of dystonia is 2-3% among the patients treated with antipsychotics, and 50% among the ones cured with conventional antipsychotics. AKATHISIA: The main feature of this curious adverse effect is the psychomotor restlessness and the inability to remain motionless. Although akathisia is not very frequent, its incidence and prevalence ranges from 5 to 50% among the treated patients. It is most probably a result of the blockage ofdopaminergic receptors. PARKINSONISM: The most frequent secondary Parkinsonism is the one caused by drugs. The characteristic parkinsonian signs regress 4 to 16 weeks after the discontinuation of antipsychotic therapy. In the era of atypical antipsychotics this adverse effect appears less frequently. TARDIVE DYSKINESIA: Involuntary choreatic movements may appear days and months after the introduction of continuous use of antipsychotics. The individual susceptibility may play the major role in the development of this side effect. CONCLUSION: Numerous studies have compared conventional and atypical antipsychotics as well as atypical ones with one another in order to decrease the risk of development of extrapyramical side effects as well as to prevent their occurrence and improve their treatment.

Kraepelin's concept of manic-depressive insanity: one hundred years later.

Kraepelin's work is frequently cited and repeatedly interpreted as groundwork for the categorical classification of mental disorders. The scope of this paper is to present a fragment of Kraepelin's contribution to the nosology of manic-depressive illness from another point of view. Studying conscientiously the original text written by Emil Kraepelin more than one hundred years ago, the reader could conclude that the author's attitudes were more in line with numerous contemporaries who promote the dimensional approach to the classification in psychiatry and spectrum concept of mood disorders. This text is an attempt to inspire the reader to examine the original textbook.

Nosological status of social phobia: contrasting classical and recent literature.

PURPOSE OF REVIEW: The aim of this review is to contrast classical and recent literature relating to social anxiety disorder in the context of its past, present and future position in classification systems. RECENT FINDINGS: Social phobia is common; it starts early and is chronic and disabling. It runs in families. Social phobia is frequently comorbid with other anxiety, mood and substance use disorders and it often precedes axis I disorders. Concerning neurobiology of social anxiety disorder research is sparse and the results are inconclusive. The data from research on genetics, early environment, temperamental features, cognitive processing, phenomenology and treatment response indicate significant overlap between social phobia and a number of other axis I and axis II disorders (avoidant personality disorder). SUMMARY: The review of the recent findings does not point to the existence of qualitative differences between social phobia and other anxiety and mood disorders. The results of recent research run against the current classification dividing anxiety and mood disorders into discrete categories and support the continuity among them. Taking into account conceptual issues of psychiatric classifications would promote subsequent research that could become a foundation for the development of psychiatric nosology.

[Current issues in psychiatry].

INTRODUCTION: Psychiatry is the branch of medicine concerned with the defining and diagnosing mental disorders, finding ways of treatment, developing methods for determining causes, and conceiving measures for prevention of mental disorders. Psychiatry has greatly advanced over the last two decades. In our country, however, due to prejudice and ignorance, mental disorders are still often considered incurable and alarming by the general public as well as by physicians, and psychiatric patients are stigmatized and marginalized by the society. THE ROLE OF PSYCHIATRY IN MODERN MEDICINE AND SOCIETY: Psychiatry has an important role in the contemporary medicine and society in general, considering the increasing number of people suffering from mental disorders, disability they cause, and their frequent simultaneous occurrence with various physical illnesses, especially chronic ones. Comorbidity of physical and mental disorders makes the treatment more difficult and time-consuming, whereas an unrecognized and untreated mental disorder has a negative impact on the prognosis and outcome of the physical illness. PSYCHIATRY AS AN INTEGRATIVE DISCIPLINE: Because of the great advances in psychopharmacology and etiopathological research, as well as development of new classifications, contemporary psychiatry integrates biological, psychological and social aspects into an integrative biopsychosocial approach to etiopathogenesis, manifestations, course, treatment, and outcome of mental disorders. In fact, this means that the etiological factors of a psychiatric disorder include mutually interacting biological (genetic, neuroanatomical, biochemical, etc), psychological (personality/temperament), and social (background, stressful life events) factors. Therefore, the treatment itself involves application of biological, psychological and social methods. THE POSITION OF'PSYCHIATRY IN OUR COUNTRY: The significant increase in the number of people suffering fiom mental disorders (depression, anxiety disorders, substance abuse disorders) underlines the importance of psychiatry in our country. It is also clear that psychiatric services need to be reformed. In order for this reorganization to be effective it is necessary to review the current conditions, include both mental health specialists and general physicians, provide financial resources, and carry it out gradually, with an adequate support from the health care administration.