Cortisol and Oxytocin Could Predict Covert Aggression in Some Psychotic Patients.

Background: The covert or indirect type of aggression has a risk of converting in violent acts and, considering that, it is very important to identify it in order to apply effective preventive measures. In cases of psychotic patients, the risk of becoming violent is harder to predict, as even neuter stimuli may be perceived as threat and trigger aggression. Treating all the psychiatric patients as potential aggressive subjects is not the best preventive measure as only a few of them are aggressive and this measure may further enhance the stigma on mentally ill patients. There is a current need for better understanding of covert aggression and to find objective measures, such as biological markers, that could be indicative of potential violent behavior. In this work, we try to investigate the role of cortisol and oxytocin as potential biomarkers of aggression in patients with psychosis. Material and Methods: We analyzed the level of peripheral oxytocin (pg/mL) and cortisol level (ng/mL) in 28 psychotic patients (they were not on psychotropic treatment at the moment of admission and those with substance abuse or personality disorder were excluded from the study) and correlated it with the intensity of aggression reported by the patient (overt and covert type) using the Overt Covert Aggression Inventory and the level of observed aggression of the patient in the past 7 days (rated by the health care provider) using the Modified Overt Aggression Scale. Results: We found that psychotic patients with a higher level of covert aggression had a lower level of cortisol (61.05 ± 8.04 ng/mL vs. 216.33 ± 12.6.9 ng/mL, p ˂ 0.01) and a higher level of oxytocin (102.87 ± 39.26 vs. 70.01 ± 25.07, p = 0.01) when compared with patients with a lower level of covert aggression. Furthermore, we observed significant negative correlation between cortisol and covert aggression (r = -0.676, p < 0.001) and between oxytocin and covert type of aggression (r = 0.382, p = 0.04). Moreover, we found that a lower level of cortisol together with a higher level of oxytocin are significant predictors of a style of internalized manifestation of aggression, with the predictive model explaining 55% of the variant of the internalized manifestation of aggression (F (2.25) = 17.6, p < 0.001, ß = 0.35, R2 = 55.2). We did not find significant correlations between cortisol and overt aggression, and neither between oxytocin and overt aggression. Positive correlations were also found between the overt type of self-reported aggression and overt aggression reported by the rater (r = 0.459, p = 0.01). Conclusions: The importance of a predictive model in understanding covert aggression is imperative and the results of our study show that oxytocin and cortisol warrant to be further investigated in establishing a definitive predictive model for covert aggression.

Religious Characteristics of Romanian Physicians: Towards an Integrative Support of Religious Psychiatric Patients.

BACKGROUND: The growing closeness between psychiatry and theology may impact positively the healthcare of the religious psychiatric patients. However, some significant divergences regarding the health care religious methods and the concept and believe in the demonic possession of psychiatric patients continue to shape the relationships between these professionals. While the religions generally admit the demonic or spirit possession as real, the current views of physicians and psychiatric patients are just taken for granted and therefore demands new investigations. In this study, we have performed a targeted survey on this subject. SUBJECTS AND METHODS: The survey was based on a questionnaire addressed to 216 psychiatrists and 201 non-psychiatrists, and 408 psychiatric patients. For physicians, the questionnaire was randomized sent to hospitals in Romania. The patients received the questionnaire on paper. Except for patients with dementia and those in the acute phase of a psychiatric illness, all psychiatric disorders available at the time of the investigation were randomized included in the study. RESULTS: The results showed that about 20% of physicians and 60% of psychiatric patients considered that demonic possession might be associated to a psychiatric illness, while the later would like a priest in the therapeutic team (89.4%, CI: 0.86-0.92). In addition, the psychiatrists declared a lower attendance of religious services, although the majority would accept a priest in the therapeutic team (p>0.05, CI: 0.61-0.70). CONCLUSION: These findings invite to a more practical collaboration between psychiatrists, clinical psychologists, and theologians/priests with training in psychiatry for a more integrative mental care of the religious psychiatric patients. The results call as well for more efficient practical solutions for psychiatric patients, raise awareness towards the personal religious needs and critical beliefs of such patients, and finally might narrow the gap of the controversy between psychiatrists, non-psychiatrists, psychologists and theologians/priests on the addressed issues.

Minireview on the Connections between the Neuropsychiatric and Dental Disorders: Current Perspectives and the Possible Relevance of Oxidative Stress and Other Factors.

Although the connections between neuropsychiatric and dental disorders attracted the attention of some research groups for more than 50 years now, there is a general opinion in the literature that it remains a clearly understudied and underrated topic, with many unknowns and a multitude of challenges for the specialists working in both these areas of research. In this way, considering the previous experience of our groups in these individual matters which are combined here, we are summarizing in this minireport the current status of knowledge on the connections between neuropsychiatric and dental manifestations, as well as some general ideas on how oxidative stress, pain, music therapy or even irritable bowel syndrome-related manifestations could be relevant in this current context and summarize some current approaches in this matter.

State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study.

BACKGROUND: Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome. OBJECTIVE: An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries. METHOD: For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered. The clinical characteristics and management of the agitation episode were also described. A descriptive analysis was performed. RESULTS: A total of 334 agitation episodes out of 7295 psychiatric emergencies were recorded, giving a prevalence rate of 4.6% (95% CI: 4.12-5.08). Of them, 172 [9.4% (95% CI: 8.2-10.9)] were attended at the ER and 162 [2.8% (95% CI: 2.4-3.3)] at AIU. Only data from 165 episodes of agitation (those with a signed informed consent form) was registered and described in this report. The most common psychiatric conditions associated with agitation were schizophrenia, bipolar disorder and personality disorder. The management of agitation included from non-invasive to more coercive measures (mechanical, physical restraint or seclusion) that were unavoidable in more than half of the agitation episodes (59.5%). CONCLUSION: The results show that agitation is a common symptom in the clinical practice, both in emergency and inpatient psychiatric departments. Further studies are warranted to better recognize (using a standardized definition) and characterize agitation episodes.

PREDICTORS OF SUICIDE RISK IN INCARCERATED MALE OFFENDERS: THE ROLE OF PERSONALITY DISORDERS.

AIM: This paper summarizes the results of a cross-sectional study aimed at exploring the role of personality disorders in predicting the suicide risk among males imprisoned for various offenses. MATERIAL AND METHODS: The data set used in analyses was based on the responses of 124 males imprisoned for various violent or non-violent offenses (M(age) = 32.39 years, SD = 8.43 years). Male offenders were interviewed using a form for demographic data and information on suicidal history. Also, they completed the Suicide Behaviors Questionnaire-Revised, as part of a broader protocol used in an ongoing study focused on the psychosocial and pharmacological aspects relevant to the diagnosis and management of personality disorders among inmates. RESULTS: At the time of data collection, forty-three respondents (34.7%) were diagnosed with at least one personality disorder. Data were analyzed using hierarchical multiple linear regression. The frequency of suicide attempts during the periods of freedom and during incarceration were significant predictors of suicide risk. Moreover, the diagnosis of personality disorder brought a significant addition to the power of final regression model, explaining almost 8% of the variance in suicide risk among the inmates. CONCLUSIONS: The findings highlight the importance of implementing prevention programs in correctional institutions, with screening and monitoring of inmates diagnosed with severe mental disorders as an important component.

ADDITIONAL DEMOGRAPHIC AND CLINICAL EVIDENCES ON THE RELEVANCE OF THE SYSTEMIC THERAPY IN ALCOHOL DEPENDENCE.

The modern treatment for alcohol dependence is still problematic, in many cases with the costs exceeding benefits. In these conditions a new management approach was developed lately, known as the systemic therapy. In this way, the crystallization and practical transposition of this new treatment approach is represented by the Clubs of Alcoholics in Treatment. These clubs are in fact a form of psycho-social intervention consisting of multi-family communities in order to maintain long-term abstinence from alcohol and to change their lifestyle and behavior. Thus, in the present paper we were interested in understanding the demographics of this systemic theory and how these aspects are influencing the final results of the therapy, as well as studying/confirming how relevant is this systemic approach on the management of alcohol dependence. Our results presented in this report bring additional evidences for the superiority of the systemic, multi-family approach of alcohol-related problems, as complemented to the standard medicinal therapy. Moreover, the data collected from patients in this study might suggest that patients with a higher educational level and therefore better capacity of understanding the information, with family support, and also with a better occupational insertion, have accepted to follow The Clubs of Alcoholics in Treatment program, with a subsequently better evolution.

The oxidative stress hypothesis in Alzheimer's disease.

Oxidative stress may be involved in many somatic and psychiatric pathological states including dementia. The hypothesis of oxidative stress involvement in dementia is supported by much scientific data through biochemical, genetic and molecular studies. Thus, there are many reports of an increased level of the markers for oxidative damage, alterations in the specific activity of the antioxidant system, mutations in specific genes, mitochondrial disturbances and also several connections between oxidative stress and amyloid plaques. Despite these evidence and clinical approaches in using antioxidant therapy in dementia treatment, studies have failed to prove a clear benefit for antioxidant treatment in dementia. Hence, there is a need for further research regarding antioxidant therapy in very early stages of dementia.

Socioeconomic implications of underdiagnosing teenagers' depression.

UNLABELLED: The aim of our research was to demonstrate once again that teenagers' depression still remains way too much underdiagnosed, the last one having important socioeconomic implications. Thus it is absolutely necessary to implement depression screening in psychiatric clinics. MATERIAL AND METHOD: The study was carried out in 2 stages, I; a group of 1126 in-patients from "Sf. Maria" Hospital, and II the analysis of the socioeconomic implications of teenagers' depression. RESULTS: Only 19, 11% of the depressive patients had a previous depression diagnosis, the rest of 80, 89% were new cases, recently diagnosed; the depressive teenagers are more exposed to drugs and alcohol abuse, to antisocial behavior, and to poorer results in school. CONCLUSION: Screening depression implementation would reduce very much the risk of teenagers' depression underdiagnosing.

[Cardiovascular risk of haloperidol vs. atypical anti-psychotic drugs in schizophrenia treatment]. / Riscul cardiovascular al haloperidolului versus antipsihotice atipice in terapia schizofreniei.

The present study examined the safety of the atypical antipsychotic drugs sertindol, olanzapine and quetiapine used in the treatment of schizophrenia. Haloperidol, a typical antipsychotic drug, was used for comparison. These data may account for the different therapeutic effects and side-effect profiles (cardiovascular risk) of typical and atypical antipsychotic drugs in schizophrenia.

[Euthanasia/assisted suicide. Ethical and socio-religious aspects]. / Eutanasia/suicidul asistat. Aspecte etice si socio-religioase.

Euthanasia/Assisted Suicide are viewed differently by moral and religious references. In a religious way, cardinal confessions (Christianity, Judaism, Islamism, Buddhism) condemn euthanasia/assisted suicide and, in the same time have a more relaxed attitude regarding passive euthanasia. Other aspects of euthanasia regard financial/economic and ethical-medical considerations. All these contradictory standpoints are expressed in some legal acts that make specifications on the concept of "euthanasia"--Oregon's Death with Dignity Act (1994) and Netherlands's Euthanasia Law (2001).

[Effect of memantine treatment on patients with moderate-to-severe Alzheimer's disease treated with donepezil]. / Efectul tratamentului cu memantina la pacientii cu boala Alzheimer moderat--severa tratati cu donepezil.

OBJECTIVE: Investigating the behavioral and cognitive effect of memantine in moderate to severe patients with Alzheimer's disease receiving donepezil. MATERIAL AND METHOD: 43 patients were enrolled in this prospective, randomized, parallel group study. There were no significant imbalances between the treatment groups in demographic and baseline clinical characteristics. Cognitive and global measures were collected at baseline and at the end of weeks 4, 8, 12 and 24. Behavioral measures were collected at baseline, at the end of week 12 and at week 24. RESULTS: Memantine--treated patients showed significantly less deterioration in their functionality. Of patients who exhibited agitation/aggression at baseline, those treated with memantine and donepezil showed significant reduction of symptoms compared with donepezil--treated patients. CONCLUSIONS: Treatment with memantine was well tolerated and reduced agitation/aggression, irritability, and appetite eating disturbances in patients who were agitated at baseline and delazed its emergence in those who were free of agitation at baseline.

Computer use and addiction in Romanian children and teenagers--an observational study.

The computer has provided some wonderful opportunities for our children. Although research on the effects of children's use of computer is still ambiguous, some initial indications of positive and negative effects are beginning t emerge. They commonly use computers for playing games, completing school assignments, email, and connecting to the Internet. This may sometimes come at the expense of other activities such as homework or normal social interchange. Although most children seem to naturally correct the problem, parents and educators must monitor the signs of misuse. Studies of general computer users suggest that some children's may experience psychological problems such as social isolation, depression, loneliness, and time mismanagement related to their computer use and failure at school. The purpose of this study is to investigate issues related to computer use by school students from 11 to 18 years old. The survey included a representative sample of 439 school students of ages 11 to 18. All of the students came from 3 gymnasium schools and 5 high schools of Iasi, Romania. The students answered to a questionnaire comprising 34 questions related to computer activities. The children's parents answered to a second questionnaire with the same subject. Most questions supposed to rate on a scale the frequency of occurrence of a certain event or issue; some questions solicited an open-answer or to choose an answer from a list. These were aimed at highlighting: (1) The frequency of computer use by the students; (2) The interference of excessive use with school performance and social life; (3) The identification of a possible computer addiction. The data was processed using the SPSS statistics software, version 11.0. Results show that the school students prefer to spend a considerable amount of time with their computers, over 3 hours/day. More than 65.7% of the students have a computer at home. More than 70% of the parents admit they do not or only occasionally discuss computer use with their children. This indicates the fact that, although they bought a computer for their children, they do not supervise the way it is used. The family is rather a passive presence, vaguely responsible and lacking involvement. But, the parents consider that, for better school results, their children should use their computers. This study tried to identify aspects of computer addiction in gymnasium and high school students, as well.

[The effects of computer-use on adolescents]. / Efectele utilizarii calculatorului la copii si adolescenti.

Computers continue to play a vital role in today's generation. The need for information about the effects of computers on their users also increases. The purpose of this study is to investigate how children and adolescents use a computer and to explore the beneficial and harmful effects of computer use on children's mental and physical health. The studied group of samples comprised 69 subjects, aged between 13 and 18 years, who answered to a questionnaire. The parents of the children also answered another questionnaire with the same subject. Data have been statistically processed using the program SPSS. The results were obtained about computer use and the pathological use was identified. Some children spend much time on computers, 4% more than five hours/day. 41% of the parents believe that the usage of the computer is favorable to the children's mental and physical health and development, 49% of parents believe that the computer may be harmful. 1.4% of the children had pathological use of the computer.