Therapist-patient relationship in treatment of chronic schizophrenic patients.

Long-term hospitalized schizophrenic patients of a whole chronic unit of a psychiatric hospital were exposed during a six-months period to a psycho-therapeutically approach of active engagement of the therapist that best can be described as "good enough mother" (Winnicot) approach or a creation of primary identification (Freeman). The effect of the treatment with special attention to the therapist-patient relationship was measured by specially designed bi-polar scale. Statistically significant differences were found on every measured quality. The research suggests that the relationship therapist-patient based on the basic trust influences the outcome of the illness.

[Diagnostic and therapeutic guidelines (algorithms) in the treatment of schizophrenia. Recommendations of the Croatian Society for Clinical Psychiatry of the Croatian Medical Association]. / Dijagnosticke i terapijske smjernice (algoritam) za lijecenje shizofrenije. Preporuke Hrvatskog drustva za klinicku psihijatriju. Hrvatskoga lijecnickog zbora.

This paper presents guidelines for the diagnosis and treatment of schizophrenia. Diagnostic guidelines are based on ICD-10 criteria for diagnosis of schizophrenia. Treatment guidelines represent a synthesis of some recently published international algorithms and our own experiences. The guidelines were presented at the seminar organized by the Croatian Association for Clinical Psychiatry and represent professional recommendations of the Association for Diagnostics and Treatment of Schizophrenia. The treatment guidelines include psychopharmacological recommendations for the selection and dosage of antipsychostics, guidelines for psychosocial interventions and psychotherapy. The treatment of the first episode, exarcerbation, relapse of illness, as well as maintenance therapy, treatment resistance and side effects are included.

Psychotic symptoms and comorbid psychiatric disorders in Croatian combat-related posttraumatic stress disorder patients.

AIM: To investigate the prevalence rate of post-traumatic stress disorder (PTSD) comorbid psychiatric disorders and to explore psychotic symptoms in patients with combat-related current PTSD. METHOD: The sample included Croatian war veterans (N=41) who were hospitalized at the University Department of Psychiatry of the Vrapèe Psychiatric Hospital during the 1995-1996 period and fulfilled the DSM-IV criteria for the current and chronic PTSD. The Schedule for Affective Disorder and Schizophrenia (SADS-L) was applied for the assessment of current and lifetime psychiatric disorders. Only three subjects had a prewar Axis I psychiatric disorder. One third of the patients met the criteria for personality disorder. RESULTS: After severe combat trauma, the majority of PTSD patients (33/41) had at least one comorbid psychiatric diagnosis on Axis I. In those with personality disorders the most frequent was alcohol dependence, whereas in those without personality disorders it was major depressive disorder. Psychotic symptoms occurred in 8 out of 41 PTSD patients. None of them had a primary psychotic disorder or a personality disorder. In all the patients, psychotic symptoms were different from flashbacks. They were symbolically related to the trauma and resistant to antipsychotic treatment. Psychotic symptoms were associated with depression in 5 out of 8 patients with psychotic symptoms. CONCLUSION: Severe and prolonged combat trauma may be followed by the co-occurrence of PTSD and psychotic symptoms, forming the atypical clinical picture of PTSD.

Psychotic symptoms in post-traumatic stress disorder.

Although many coexisting disorders have been reported with post-traumatic stress disorder (PTSD), little reference has been made to the presence of psychotic symptoms. Psychotic symptoms are not included in the Diagnostic and Statistical Manual of Mental Disorders IV or International Classification of Diseases 10 diagnoses of PTSD. The hallucinations and delusions described here in two cases of PTSD were accompanied by psychotic symptoms. These symptoms clearly differ from flashbacks but have a strong symbolic relationship to the trauma, and they do not respond to antipsychotic drugs. The question is whether there are two separate diagnoses or if psychotic symptoms are an integral part of PTSD. More systematic studies are required to explore the possibility of changing the current classifications of PTSD to include a diagnosis of PTSD with psychotic features.

Bruxism and psychobiological model of personality.

Bruxism is an abnormal activity of the masticatory system, caused by both psychological and occlusal factors. The aim of the study was to determine the possible correlation between the temperament and character of patients and bruxism. Personality profile of 35 bruxism patients, with no history of psychiatric disorder, was studied by means of Cloninger's seven factor model of temperament and character. For diagnosis of bruxism, muscle activity was analysed and occlusal interferences and facets were registered by clinical functional analysis. Temperament and Character Inventory assesses four dimensions of temperament and three dimensions of character. Results suggest that bruxism patients can have following personality traits: exploratory, impulsive, extravagant and irritable, pessimistic, fearful, shy and fatigable, critical, aloof, detached and independent, lazy, spoiled, underachiever and pragmatist. Combined scores of character dimension indicate immature dimensions of character. Inventory is not standardized for the Croatian population, therefore the result should be taken with caution.

Association analysis of the 5-HT2C receptor and 5-HT transporter genes in bipolar disorder.

We selected 42 patients with bipolar disorder type I (BPI) and 40 healthy controls for genetic analysis of DNA polymorphisms in the serotonin receptor 2c (5-HTR2c) and serotonin transporter (5-HTT) genes. No significant associations were found in the total patient sample. However, when the individuals were divided according to gender, trends for association with both polymorphisms (P = 0.051 for 5-HTR2c and P = 0.049 for 5-HTT) in female patients were observed. These results suggest that variations in these genes may be responsible for a minor increase in susceptibility for bipolar disorder in women.

Analysis of the tyrosine hydroxylase and dopamine D4 receptor genes in a Croatian sample of bipolar I and unipolar patients.

We selected 83 patients with bipolar disorder type I or unipolar recurrent major depression and 71 healthy controls for genetic analysis of the tyrosine hydroxylase and the dopamine D4 receptor gene. No significant association was found between bipolar disorder type I and unipolar recurrent major depression and the polymorphisms located near these genes. Therefore, the hypothesis that the tyrosine hydroxylase and the dopamine D4 receptor genes may be involved in the etiology of bipolar disorder and unipolar recurrent major depression is not supported in our study.

Positive association between the GABRA5 gene and unipolar recurrent major depression.

The gamma-aminobutyric acid (GABA) neurotransmitter system has been implicated in the pathogenesis of mood disorders. To test this hypothesis we carried out an association study between a dinucleotide repeat polymorphism in the GABAA receptor alpha 5 subunit gene and bipolar and unipolar mood disorders. Our results suggest a possible involvement of this gene in unipolar but not in bipolar disorder.