Referrals For Gender-Affirming Hormone Treatment in Croatia's National Network for Transgender Healthcare.

A network of healthcare professionals specializing in transgender care was established in Croatia in 2011, and legal advancements were subsequently made in 2014. Both achievements made gender transition more transparent and thus more attainable in Croatia. This observational study was conducted to assess the number of transgender individuals initiating gender-affirming hormone treatment (GAHT) in Croatia and describes trends in age and sex assigned at birth. Between 2011 and 2022, a total of 111 transgender individuals initiated GAHT. Within the cohort, 52 were assigned male at birth (AMAB) and 59 were assigned female at birth (AFAB). The overall annual incidence rate of transgender individuals initiating GAHT was 0.52 per 100,000 age-adjusted individuals. There was a statistically significant increase (p < 0.01) in transgender individuals commencing GAHT before the COVID-19 pandemic. Furthermore, a rising trend toward masculinizing rather than feminizing treatment was identified (p < 0.05), particularly among younger transgender individuals. The COVID-19 pandemic disrupted these trends in 2020, except for the trend of initiating therapy at a younger age (p < 0.01). The annual incidence and age distribution trends of transgender individuals initiating GAHT in Croatia closely mirrored those in other European countries, with a higher prevalence of individuals assigned female at birth. The study underscores a significant rise in the number of individuals initiating gender-affirming hormone treatment, emphasizing the need for proper legal regulation and healthcare system response.

Depression and stress levels in patients with different psychiatric disorders during concurrent early-phase COVID-19 pandemic and earthquake in Croatia.

BACKGROUND: While Croatia shared COVID-19 pandemic with other countries, its capital area was also hit by a 5.6 magnitude earthquake. The simultaneous impact of these two disasters on psychiatric patients is largely unknown, and we addressed those knowledge gaps. METHODS: The cross-sectional study was conducted during the pandemic's first peak, in the aftermath of earthquake, by telephonic survey. Measurements included the Patient Health Questionnaire-9, the Perceived Stress Scale and the semi-structured interview to evaluate the impact of pandemic stress and earthquake. Overall 396 patients with depression and/or anxiety disorders (DAD), 229 participants with schizophrenia spectrum disorders (SSD) and 205 healthy controls were enrolled. RESULTS: Both patient groups had higher depression and stress levels than controls, independent of sex, age and the presence of somatic comorbidity. After controlling for the same covariates, patient groups had higher COVID-19- and earthquake-related fears than controls. In patients with DAD, both fears were greater than among SSD patients. When comparing the two fears, the fear from earthquake was higher in DAD and control groups, whereas in SSD patients there was no such difference. CONCLUSIONS: Patients with DAD were the most vulnerable group during disasters, while earthquake seems to be associated with more fear than the pandemics, at least in DAD patients and healthy individuals. Future longitudinal studies should determine if early psychological support might alleviate stress levels after disasters and prevent further worsening of mental health, particularly among DAD patients.

Illuminating the way: the role of bright light therapy in the treatment of depression.

INTRODUCTION: Despite the growing number of different therapeutic options, treatment of depression is still a challenge. A broader perspective reveals the benefits of bright light therapy (BLT). It stimulates intrinsically photosensitive retinal ganglion cells, which induces a complex cascade of events, including alterations in melatonergic, neurotrophic, GABAergic, glutamatergic, noradrenergic, serotonergic systems, and HPA axis, suggesting that BLT effects expand beyond the circadian pacemaker. AREAS COVERED: In this review, the authors present and discuss recent data of BLT in major depressive disorder, non-seasonal depression, bipolar depression or depressive phase of bipolar disorder, and seasonal affective disorder, as well as in treatment-resistant depression (TRD). The authors further highlight BLT effects in various depressive disorders compared to placebo and report data from several studies suggesting a response to BLT in TRD. Also, the authors report data showing that BLT can be used both as a monotherapy or in combination with other pharmacological treatments. EXPERT OPINION: BLT is an easy-to-use and low-budget therapy with good tolerability. Future studies should focus on clinical and biological predictors of response to BLT, on defining specific populations which may benefit from BLT and establishing treatment protocols regarding timing, frequency, and duration of BLT.

Plasma Brain-Derived Neurotrophic Factor Levels in First-Episode and Recurrent Major Depression and before and after Bright Light Therapy in Treatment-Resistant Depression.

Brain-derived neurotrophic factor (BDNF) is implicated in the etiology and treatment response in major depressive disorder (MDD). However, peripheral BDNF concentrations have not been compared across different MDD stages. Bright light therapy (BLT) offers some potential in treatment-resistant depression (TRD), but its effects on BDNF levels are unknown. This study included a cross-sectional analysis of plasma BDNF concentration in females with TRD, unmedicated MDD patients, and healthy controls (HC), and measurements of longitudinal BLT effects on plasma BDNF levels in TRD patients. The present study included 55 drug-naïve, first-episode patients, 25 drug-free recurrent-episode MDD patients, 71 HC participants, and 54 TRD patients. Patients were rated by Hamilton Depression Rating Scale (HAMD)-17 and the Montgomery-Åsberg Depression Rating Scale (MADRS). Patients with TRD received BLT during 4 weeks. The total HAMD-17 and MADRS scores decreased following BLT. All patient groups had lower plasma BDNF than HC, but BDNF levels did not differ between first- and recurrent-episode BDNF patients and TRD patients before or after BLT. However, responders and remitters to BLT had higher post-treatment plasma BDNF concentrations than patients who did not achieve response or remission. The changes in plasma BDNF levels may be candidates for biomarkers of treatment response to BLT in TRD patients.

Are the Persistent Postural-Perceptual Dizziness (PPPD) Patients More Anxious than the Patients with Other Dizziness?

BACKGROUND: The Behavioral Subcommittee of the Bárány Society Committee for Classification of Vestibular Disorders recently established the diagnostic criteria for a persistent postural-perceptive dizziness (PPPD). OBJECTIVES: This study aims to determine how significant the degree of anxiety and depression of PPPD patients is, compared to the patients with other dizziness. SUBJECTS AND METHODS: The study was conducted on 78 patients, 39 (50%) of whom suffer from PPPD, and of a control group consisting of the same number of patients with other types of dizziness. All the patients filled out the DHI and HADS questionnaire and were subjected to a VNG and VEMP examination. RESULTS: The DHI showed significant disability in the majority of patients, slightly more in the control group. The HADS showed an equal degree of anxiety in both groups of patients, but significantly higher pathological anxiety in the PPPD group (49%:31%). CONCLUSIONS: Majority of the patients in both groups experienced mild anxiety, while those with the pathological degree were more represented in the PPPD group. Depression was more expressed in the group of other dizziness. We can consider only the patients with a pathological degree of anxiety as predisposed to the emergence of PPPD.

Mental Health of Psychiatrists and Physicians of Other Specialties in Early COVID-19 Pandemic: Risk ind Protective Factors.

BACKGROUND: Many research has indicated that, during the COVID-19 pandemic, health care workers are under greatly increased pressure and at increased risk for the development of mental health problems. Furthermore, previous research has indicated that psychiatrists are exposed to a number of unique stressors that may increase their risk for poor mental health. The aims of the present study were to assess the level of COVID-19 related concerns, psychological distress and life satisfaction among psychiatrists and other physicians during the first period of the pandemic and to examine whether individual differences in COVID-19 concerns, psychological flexibility, psychological resilience and coping behaviors account for differences in mental health indicators. SUBJECTS AND METHODS: The sample consisted of N=725 physicians, among whom 22.8% were psychiatrists. This study was conducted online during the first lockdown in Croatia and collected data regarding COVID-19 related concerns, coping behaviors and mental health indicators (Psychological Distress and Life Satisfaction). RESULTS: Physicians of other specialties had higher scores on a measure of COVID-19 anxiety than psychiatrists (p=0.012). In addition, a number of differences in coping behaviors are evident. Specifically, psychiatrists were less likely than physicians of other specializations to believe that being informed about COVID-19 is an effective coping strategy (p=0.013), but more prone to using sedatives and drugs as a coping strategy (p=0.002; p=0.037). CONCLUSIONS: Psychiatrists are at special risk for substance abuse. Younger age, psychological inflexibility, low resilience and greater COVID-19 concerns might act as specific risk factors for distress. Our findings highlight the need for promoting a healthy lifestyle and psychological flexibility as universal protective factors.

Prediction of posttraumatic stress disorder symptomatology after childbirth - A Croatian longitudinal study.

BACKGROUND: Following childbirth, a vast number of women experience some degree of mood swings, while some experience symptoms of postpartum posttraumatic stress disorder. AIM: Using a biopsychosocial model, the primary aim of this study was to identify predictors of posttraumatic stress disorder and its symptomatology following childbirth. METHODS: This observational, longitudinal study included 372 postpartum women. In order to explore biopsychosocial predictors, participants completed several questionnaires 3-5 days after childbirth: the Impact of Events Scale Revised, the Big Five Inventory, The Edinburgh Postnatal Depression Scale, breastfeeding practice and social and demographic factors. Six to nine weeks after childbirth, participants re-completed the questionnaires regarding psychiatric symptomatology and breastfeeding practice. FINDINGS: Using a multivariate level of analysis, the predictors that increased the likelihood of postpartum posttraumatic stress disorder symptomatology at the first study phase were: emergency caesarean section (odds ratio 2.48; confidence interval 1.13-5.43) and neuroticism personality trait (odds ratio 1.12; confidence interval 1.05-1.20). The predictor that increased the likelihood of posttraumatic stress disorder symptomatology at the second study phase was the baseline Impact of Events Scale Revised score (odds ratio 12.55; confidence interval 4.06-38.81). Predictors that decreased the likelihood of symptomatology at the second study phase were life in a nuclear family (odds ratio 0.27; confidence interval 0.09-0.77) and life in a city (odds ratio 0.29; confidence interval 0.09-0.94). CONCLUSION: Biopsychosocial theory is applicable to postpartum psychiatric disorders. In addition to screening for depression amongst postpartum women, there is a need to include other postpartum psychiatric symptomatology screenings in routine practice.

Predictors of Exclusive Breastfeeding 6-9 Weeks After Delivery: a Prospective Cohort Study. Public Mental Health Perspective.

BACKGROUND: There are numerous benefits of exclusive breastfeeding (EBF) on mother and child wellbeing. The objective was to find out whether depression, posttraumatic stress disorder and personality traits at the time of delivery are associated with EBF six to nine weeks after delivery. SUBJECTS AND METHODS: The targeted population were women who delivered in Croatian largest University maternity hospital. The scores of The Edinburgh Postnatal Depression Scale (EPDS), The Big Five Inventory (BFI) and The Impact of Events Scale (revised) - IES-R three to five days after childbirth were measured to predict self-reported EBF status six to nine weeks after the delivery. Six to nine weeks after the delivery data on breastfeeding were collected for 259 (69.6%) out of initially 372 enrolled women. RESULTS: Six to nine weeks after the delivery 151/259 (58.3%) were still exclusively breastfeeding their child. After adjustment for all other variables, women who gave their second childbirth had significantly higher odds for longer EBF than primiparous women (OR=2.12; 95% CI 1.10-4.10). Higher EPDS result was significantly associated with lower odds for EBF (OR=0.92; 95% CI 0.85-0.99). CONCLUSION: Parity and depressed mood immediately after the delivery are associated with EBF six to eight weeks after the delivery. Depression symptoms are a moderator between parity and exclusive breastfeeding, so multiparous women without depressive symptomatology are more prone for EBF.

Changes in trait brainwave power and coherence, state and trait anxiety after three-month transcendental meditation (TM) practice.

BACKGROUND: The amount of studies showing different benefits of practicing meditation is growing. EEG brainwave patterns objectively reflect both the cognitive processes and objects of meditation. This study aimed to examine the effects of transcendental meditation (TM) practice on baseline EEG brainwave patterns (outside of meditation) and to examine weather TM reduces state and trait anxiety. SUBJECTS AND METHODS: Standard EEG recordings were conducted on volunteer participants (N=12), all students or younger employed people, before and after a three-month meditation training. Artifact-free 100-second epochs were selected and analyzed by Fast Fourier Transformation (FFT) analysis. Endlers Multidimensional Anxiety Scales (EMAS) were used to assess anxiety levels. Power (µV(2)) and coherence levels were compared in the alpha, beta, theta and delta frequency band. RESULTS: Changes in EEG patterns after meditation practice were found mostly in the theta band. An interaction effect was found on the left hemisphere (p<0.10). Theta power decreased on the left, but not on the right hemisphere. Increased theta coherence was found overall and in the central, temporal and occipital areas (p<0.10). Decrease in alpha power was found on channels T3 (p<0.10), O1 (p<0.05) and O2 (p<0.10). An interaction effect was found in the delta frequency band (p<0.06), too. A trend for power decreasing was found on the left, and a trend for power increasing on the right hemisphere. Also, power decreased on channel O1 (p<0.10). In the beta frequency band, a decrease was found on channel O2 (p<0.10). Trait anxiety did not differ, but a decrease in state anxiety and cognitive worry was found (p<0.05). CONCLUSIONS: Obtained results confirm the effects of TM on some baseline EEG brainwave patterns and state anxiety, suggesting that the left hemisphere is more sensitive to meditation practice. Most of the changes were found in the occipital and temporal areas, less in the central and frontal areas. State anxiety decreased after TM practice. Findings suggest TM practice could be helpful in treating different kinds of disorders, especially anxiety disorders.

Multivariate analysis of predictors of depression symptomatology after childbirth.

BACKGROUND: Risk factors of postpartum depression, although relatively well investigated, remain largely unclear. The aim of this study was to identify the most relevant predictors of postpartum depressive symptomatology that are of clinical importance using the Edinburgh Postnatal Depression Scale (EPDS) 3-5 days and 6 to 9 weeks after childbirth. SUBJECT AND METHODS: In order to explore predictors of depression, 3-5 days after childbirth, 372 participants fulfilled several questionnaires: Edinburgh Postnatal Depression Scale (EPDS), Impact of Events Scale Revised (IES-R), Big Five Inventory, and questions regarding breastfeeding practice as well as social and demographic factors. Six to nine weeks after childbirth, the same participants fulfilled the following questionnaires: IES-R, EPDS and breastfeeding practice questions. RESULTS: On a multivariate level of analysis, the predictors that increased the odds for postnatal depression symptomatology at the first study point were: unsuccessful breast feeding initiation (odds ratio (OR) 2.58; confidence interval (CI) 1.35-4.91) and personality traits neuroticism (OR 1.16; CI 1.07-1.25.). The predictors that increased the odds for depression symptomatology at the second study phase were: fear for labor outcome (OR 2.44; C1.03-5.80) and the baseline EPDS score (OR 3.32; CI 1.31-8.40). The predictor that decreased the odds at the second study phase was the personality trait Openness (OR 0.9; CI 0.86-0.99). CONCLUSIONS: Immediately after childbirth biological and psychological factors seem to be predictive for postpartum symptomatology while later only psychological factors are of greater importance.

Quantitative electroencephalography in schizophrenia and depression.

BACKGROUND: Standard (qualitative) electroencephalography (EEG) is routinely used in the diagnostic evaluation of psychiatric patients. Quantitative EEG (qEEG) findings differ between patients with schizophrenia, patients with depression, but results are not consistent. The aim of our study was to determine the differences in qEEG parameters between patients with schizophrenia, patients with depression, and healthy subjects. SUBJECTS AND METHODS: The study included 30 patients with schizophrenia, 33 patients with depression, and 30 healthy subjects. All study participants underwent standard EEG. Artifact-free 100-second epochs were selected from the recorded material and analyzed with Fast Fourier Transformation (FFT) analysis. RESULTS: The results are presented as absolute spectral power values (µV2) of delta, theta, alpha, and beta components of the EEG spectrum. EEGs were recorded from 12 locations including Fp1, Fp2, F3, F4, F7, F8, T3, T4, P3, P4, O1, and O2. In comparison with healthy subjects, patients with schizophrenia showed increased delta, theta, and beta activity and decreased alpha activity. Similar results were obtained in patients with depression, but in fewer regions. In patients with schizophrenia, delta power over Fp1, Fp2, F4, and F8 regions was increased in comparison with those in patients with depression. Interhemispheric asymmetry was found in patients with schizophrenia and healthy subjects, but not in patients with depression. CONCLUSION: The finding that patients with schizophrenia differed from patients with depression in delta power values could be potentially used in differential diagnosis between schizophrenia and depression. The role of qEEG in clinical differentiation between these two mental disorders may be especially important in cases of negative-symptom schizophrenia.

EEG characteristics in depression, "negative" and "positive" schizophrena.

OBJECTIVE: qEEG investigations present differences in the comparison of schizophrenic patients and healthy examinees, as well as of depressive patients and healthy controls. The comparison of "positive" and "negative" schizophrenia also presents differences in the qEEG parameters. Changes in qEEG are various in these studies, but not always consistent. In this research we wanted to compare "positive" schizophrenia, "negative" schizophrenia and depression. SUBJECTS AND METHODS: The sample comprised 55 examinees (all women): 20 patients with "positive" schizophrenia, 15 patients with "negative" schizophrenia and 20 patients with depression. The standard EEG registration was done in all of them. From the recorded material, the 20-second period without artifacts was analyzed by the FFT method. The results were presented as absolute special power values (muV(2)) for individual segments of the spectrum: delta (0.5-4.0), theta (4.0-8.0), alpha (8.0-13.0) and beta (13.0-30.0). The observed regions included Fp1, Fp2, F3, F4, F7, F8, T3, T4, P3, P4, O1 and O2. RESULTS: The "positive" type schizophrenia differs from the "negative" in the increase in both delta and theta activities, and in the decline of beta activity over frontal regions. The "positive" type of schizophrenia differs from depression in the increase in delta activity over frontal regions, while the "negative" form of schizophrenia differs from it in the decrease in beta activity over frontal regions. CONCLUSIONS: qEEG parameters differ in the comparison of "positive" and "negative" types of schizophrenia. These differences are more numerous and more significant than those obtained in the comparison of each of these types of schizophrenia with depression.

Psychoeducation versus treatment as usual in diabetic patients with subthreshold depression: preliminary results of a randomized controlled trial.

BACKGROUND: Research on the effects of treating sub-threshold depression in persons with diabetes is scarce in spite of the findings indicating that this condition is highly prevalent in the diabetic population and may increase the risk of developing a subsequent major depression. This study was aimed at exploring the effects of a psycho-educational intervention on depression- and diabetes-related outcomes in patients with mild to moderate depressive symptoms. METHODS: A randomized controlled study design with a one-year follow-up was used. Fifty patients with mild to moderate depressive symptoms (74% female, aged 57 +/- 9 yrs, diabetes duration of 10 +/- 8 yrs, BMI 31 +/- 6 kg/m2, HbA1C 7.7% +/- 1.4, 53% insulin treated) were randomly assigned to either an intervention or a control group. The intervention group underwent four psycho-educational sessions aimed at enabling self-management of depressive symptoms. The control group was informed about the screening results and depression treatment options while continuing diabetes treatment as usual. Both groups were contacted by phone in 2-3-month intervals, and re-assessed for depression after 6 and 12 months. Changes in depressive symptoms and glycaemic control were considered primary outcomes. Mann-Whitney U test and Friedman ANOVA were used to compare between- and within-group indicators at 6- and 12-month follow-ups. RESULTS: Both the intervention and the control group reported a significant decrease in depressive symptoms as measured by the CES-D scale (Friedman ANOVA chi2 = 10.8 p = .004 and chi2 = 7.3 p = 0.03, respectively). The 6-month and 1-year indicators of glycaemic control as compared to baseline HbA1C values were also improved in both groups (chi2 = 11.6 p = 0.003 and chi2 = 17.1 p = 0.0002, respectively). Between-group differences in depressive symptoms and HbA1C values were not statistically significant either at 6- or at 12-month follow-up (all p > 0.05). CONCLUSION: Psycho-educational treatment appears to be beneficial in diabetic patients with mild to moderate depressive symptoms, but its effects are comparable with the non-specific support given to the subjects in the control group. TRIAL REGISTRATION: Current Controlled Trials ISRCTN58745372.

Acute stress and depression 3 days after vaginal delivery--observational, comparative study.

During the first month postpartum, 85% of women experience some form of mood disorders. The most common are: postpartum blues, non-psychotic postpartum depression, puerperal psychosis. Delivery of a child can be traumatic for some women. Several authors have found that women could get symptoms of one form of posttraumatic stress disorder (PTSD) after childbirth. However, etiology of established postpartum disorders is still unknown. The aim of this study is to detect symptoms of acute stress reaction and acute depressive state as a consequence of peripartal complications, as early as three days postpartum using Impact of Events Scale revised (IES-R) and the Edinburgh Postnatal Depression Scale (EPDS) questionnaires and to demonstrate their potential usage for the early detection of vulnerable mothers with greater risk to develop any of postpartum psychiatric disorder, including PTSD. For that purpose 103 subjects, without previous medical history of psychiatric illness, were included in the investigation. Long duration of delivery (> or = 12 h), very painful delivery, complication and illness of mother during and after delivery as a consequence of delivery, preterm delivery (before week 36) and/or illness of the child (as a consequence of delivery or congenital) are considered to be risk factors for acute stress reaction and acute depressive state after delivery. Sixty one out of 103 investigated mothers had one or more researched peripartal complications. A statistically significant difference has been found between the control (n=42) and the peripartal complications (n=61) groups in both the mean IES-R (4.67 +/- 5.43 and 13.50 +/- 14.12, respectively, p < 0.01) as well as in the mean EPDS (3.85 +/- 2.76 and 7.03 +/- 3.90, respectively, p < 0.01) scores. Additionally, while there were 4 cases of acute stress reactions and 3 cases of acute depressive state in the peripartal complications group there were no cases of these states in the control group. Based on our findings we conclude that using IES-R and EPDS questionnaires as early as three days after delivery could provide an early detection of previously healthy mothers with greater risk for development of postpartum psychiatric disorders.

Psychosocial factors contributing to persistent depressive symptoms in type 2 diabetic patients: a Croatian survey from the European Depression in Diabetes Research Consortium.

OBJECTIVE: The study was aimed at exploring a 1-year course of depression in persons with type 2 diabetes and analysing demographic, disease-related, and psychological variables that may predict persistent depressive symptoms. PATIENTS AND METHODS: One hundred patients from a randomly selected sample of 470 outpatients were found to be suffering from severe depressive symptoms. They were followed and re-examined for depression after 1 year. Baseline depression was assessed by the Center for Epidemiologic Studies--Depression scale (CES-D) and a face-to-face diagnostic interview relying on the DSM-IV. Nonparametric tests for between-group differences were used to compare patients who recovered from depression with those who still suffered from severe depressive symptoms. Multiple logistic regression was used to determine predictors of depression persistence. RESULTS: Seventy-nine of 100 patients with baseline depression scores indicative of severe depression were reached at 1-year follow-up. Among them, 53% were shown to have improved depressive symptoms to CES-D <16, while 47% continued to suffer from severe depressive disturbances (CES-D >or=16). Logistic regression analysis indicated that psychosocial variables predicted persistently elevated depressive symptoms better than demographic and diabetes-related ones. Clinical depression at baseline (OR=3.8, CI 1.31-10.98, P=.01), diabetes-related distress (OR=3.3, CI 1.01-10.98, P=.05), and social and physical quality-of-life aspects (OR=0.92, CI 0.88-0.97, P=.0005 and OR=0.94, CI 0.90-0.98, P=.002, respectively) were shown to be independent predictors of 1-year depression outcomes. CONCLUSIONS: Severity of baseline depression, a degree to which depression disrupted the patients' quality of life, and concomitant emotional problems related to diabetes were shown to be associated with persistently elevated depressive symptoms.

Serum lipid levels and suicidality among male patients with schizoaffective disorder.

Suicidal behavior in schizoaffective disorder is a serious problem and suicide risk during lifetime ranges between 5%-10%. Neurobiology of suicidal behavior has not been studied sufficiently, and a high number of studies are oriented toward lipid investigation. The aim of our study was to investigate whether there were differences in the level of lipids (cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides) in hospitalized suicidal (n=20) and non-suicidal (n=20) patients with schizoaffective disorder. The study also included male healthy control subjects (n=20). Hamilton Depression Rating Scale (HDRS-17), and Positive and Negative Syndrome Scale (PANSS) were used to confirm the level of psychopathology in patients with schizoaffective disorder. Severity of suicidality was measured by Scale for Suicide Ideation (SSI) at time of admission. Results of the study indicated significantly lower concentrations of cholesterol (p<0.001), LDL-cholesterol (p<0.01) and HDL-cholesterol (p<0.01). There were no differences in the number of previous hospitalization and previous suicide attempts between suicidal and non-suicidal patients (p>0.05). Duration of the illness was significantly (p<0.05) shorter in suicidal patients. Suicidal patients also had a significantly higher score on HDRS-17 (p<0.001) and PANSS (p<0.01) compared to non-suicidal patients.

Heterogeneity of posttraumatic stress disorder symptoms in Croatian war veterans: retrospective study.

AIM: To determine the relationship between the intensity of combat-related posttraumatic stress disorder (PTSD) and the intensity of predominating symptoms. METHOD: The study included 151 veterans from 1992-1995 war in Croatia (aged 38.3+/-7.3 years) with PTSD. The veterans were psychologically tested with the Mississippi Scale for Combat-related PTSD (M-PTSD), Questionnaire on Traumatic Combat and War Experiences (USTBI-M), and Minnesota Multiphasic Personality Inventory-version 201 (MMPI-201). RESULTS: The discriminative analysis of the data revealed that the group with lower PTSD intensity had the highest scores on MMPI scales D (depression, T-score 98.3+/-5.6), Hs (hypochondriasis, 90.1+/-5.1), and Hy (hysteria, 89.5+/-4.9), whereas the group with higher PTSD intensity, besides these three scales (D=95.7+/-5.3; Hs=87.6+/-4.3; Hy=85.6+/-4.7), also had clinically significantly elevated Pt (psychastenia, 80.6+/-5.6), Sc (schizophrenia, 79.6+/-4.8), and Pa (paranoia, 85.6+/-5.4) scales, with the highest Pa scale. CONCLUSION: It was possible to differentiate study participants with different PTSD intensity on the basis of their MMPI profile. More intense PTSD was associated with externalized symptoms, such as aggression, acting-out, hostility, and mistrust, whereas less intensive PTSD was associated with mostly depressive symptoms. Our study showed that different intensity of PTSD has different symptom patterns.