The effect of vortioxetine on anhedonia in patients with schizophrenia.

OBJECTIVE: Anhedonia is a common symptom of depression, but is also a negative symptom of schizophrenia. The purpose of this study was to examine the effects of vortioxetine on anhedonia in patients with schizophrenia. METHODS: A total of 120 patients with schizophrenia in remission who met inclusion criteria were randomized 1:1 by the envelope method into intervention and control groups. All participants in both groups were divided into three subgroups based on the antipsychotic therapy they were receiving (olanzapine, risperidone, or aripiprazole). Vortioxetine was administered to those in the intervention group at a fixed dose of 10 mg per day. The Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), and Chapman Scale for Social and Physical Anhedonia (CSPA) were administered. The study lasted 12 weeks. Participants were assessed twice: At baseline and at the end of the study. Six participants dropped out, with 114 completing the trial. FINDINGS: Vortioxetine treatment had a significant effect on level of physical anhedonia. The treatment interaction was also statistically significant, but with a relatively small effect (F = 3.17, P < .05; η2 = .061). Vortioxetine treatment had a particularly strong effect on the level of social anhedonia. The interaction between the treatment and the type of antipsychotics was also statistically significant with a small effect (F = 5.04, P < 0. 01; η2 = .091). CONCLUSION: The combination of olanzapine and vortioxetine was found to be the best option to reduce symptoms of social and physical anhedonia in these patients with remitted schizophrenia.

Comparison of binge-eating disorder and food addiction.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, binge-eating disorder (BED) is classified as episodes of binge eating while not being hungry, eating too fast until feeling uncomfortably full, or eating in solitude with feelings of shame and disgust after eating, without compensatory mechanisms. The controversial disorder food addiction (FA) is characterized by overconsumption, cravings, failure to cut down on amounts of food, and withdrawal and tolerance to overeating. In this narrative review, we aimed to comprehensively characterize and compare BED and FA. We searched PubMed using the keywords "binge-eating disorder" and "food addiction." We finally included 51 publications according to topic specificity, credibility, the authors' reputation, and non-bias criteria. BED is characterized by concerns about dietary issues, body shape, and weight as well as depressive symptoms and brooding rumination. FA can be divided into substance addiction and behavioral addiction, which can be differentiated using a list of criteria including hunger, taste, pleasure, function of food, loss of social connections, weight concerns, and awareness about the disorder. Further research is needed to further characterize and distinguish BED and FA.

Synthetic cannabinoids awareness among patients with opioid use disorder in Serbia - A survey based cross-sectional pilot study.

Introduction: There is limited data on the awareness and use of synthetic cannabinoids (SCs) in high-risk population in Serbia, despite SCs becoming more and more common at illicit drug market. Aim: This pilot study aimed to examine the awareness and prevalence of use of SCs in patients with an opioid-use disorder and to identify patient characteristics and other factors associated with SCs use. Patients and methods: This cross-sectional study was conducted at the Clinic for Psychiatry, Clinical Center Vojvodina, Serbia, the largest tertiary health care institution in this region of the country. All patients hospitalized due to the treatment of opioid dependence during November and December 2017 were included (response rate 100%), and filled-out an anonymous questionnaire specifically developed for the purpose of this study. Differences between patients reporting SCs use and those who did not were compared using chi-square test with values of p < 0.05 were considered significant. Results: Out of 64 patients (median age 36.37 years), one third (32.81%) reported using SCs. Socio-demographic characteristics of the subjects were not associated with SCs use. There were differences in the most common sources of information reported between the SCs users and non-users. Majority of SCs users (76.0%) were informed about SCs through friends, compared with just 26.0% of non-users (<0.001). Nearly all study participants (93.8%) were daily tobacco users. The share of respondents reporting alcohol and marihuana use was significantly higher among the SCs users (52.0% vs. 20.9%, p = 0.011 and 15.6% vs. 12.5%, p = 0.015), respectively. Higher share of SCs users used multiple psychoactive substances (38.1% vs. 16.3%), and this difference was statistically significant (p = 0.047). The most commonly reported adverse effect of SCs among users included dry mouth (81.0%), trouble thinking clearly (52.4%) and panic attacks (52.4%). Conclusion: Understanding the awareness and use of SCs among high-risk drug users, as well as associated factors can help improve substance-use disorder treatment in our setting. Educational activities targeting public are urgently needed to raise awareness on SCs, considering that social contacts are the main sources of information on SC for this vulnerable population. Users of SCs have also reported using other psychoactive substances more often, and this calls for a holistic approach addressing multiple factors to improve substance-use treatment in our setting.

Cardiovascular effects of methadone and concomitant use of diazepam during methadone maintenance treatment induction: low concentration risk.

BACKGROUND: The aim is to evaluate the role of diazepam concentrations in development of low-concentration-methadone-associated QTc prolongation in patients with opioid use disorder during methadone maintenance treatment (MMT) induction. RESEARCH DESIGN AND METHODS: Individuals with addiction disorder on MMT were studied before the beginning of MMT and after one and six months of MMT. Serum concentrations of methadone, diazepam, electrolytes and ECG were analyzed. RESULTS: Thirty patients were enrolled. The mean methadone concentration at time points was 177 ± 119 ng/ml and 343 ± 182 ng/ml, while the mean diazepam concentration was 561 ± 437 ng/ml and 1045 ± 933 ng/ml. The QTc interval before the introduction of MMT, after 1 and 6 months of MMT were 412 ± 27 ms, 425 ± 18 ms and 424 ± 15 ms, respectively, showing statistically significant increase in the length of QTc interval after 1 and 6 months of MMT. Statistically significant correlation between the concentration of methadone and QTc interval length at observed time points (R2 = 0.239, p = 0.018; R2 = 0.513, p = 0.006) was shown, and it remained so if the concentration of diazepam was included (R2 = 0.347, p = 0.026, R2 = 0.513, p = 0.009). CONCLUSIONS: The prolongation of QTc below the risk threshold in low methadone therapeutic doses has been recorded and concomitant use of diazepam could be a co-factor in such issue.

Drug Addiction as Risk for Suicide Attempts.

INTRODUCTION: Suicide is closely linked to the substances use. Therefore it is very important to confirm the factors that affect the possibility of suicidal behavior. METHODOLOGY: The survey included 200 respondents; 100 heroin addicts on the substitution program that attempted suicide and 100 opiate addicts who have not attempted suicide. The evaluation included a questionnaire with socio-demographic, hereditary and addiction data, legal problems and then the Minnesota Multiphasic Personality Inventory-MMPI-2. RESULTS: The results showed a statistically significant difference compared to the personality structure, especially pronounced in hypersensitive structures, in relation to the duration of addictive experience and duration of heroin by intravenous route, as well as in relation to the presence of psychotic disorders, drug abuse and suicidal behavior in the family. CONCLUSION: As risk factors among opiate addicts are indentified interfered biological and psychological factors and the effects of the substances themselves.

[Manufacturing process of high quality phytopreparation on example of herbal sedative].

INTRODUCTION: Rational phytotherapy is a modern concept of using plant-originated drugs which has emerged from the need to improve phytotherapy in order to make the use of herbal remedies more efficient and safer. The aim of this study was to give the health-care workers more information on the manufacturing process of high quality phytopreparation following principles of Good Manufacturing Practice and Good Laboratory Practice on the example of herbal sedative, Odoval S capsules. MATERIAL AND METHODS: This study was designed to reflect the production process of a high-quality and safe herbal remedy, starting from defining the formulation and the production procedure to the quality control of raw materials, characterization of the final product, and testing stability of active ingredients in the capsules. RESULTS: Formulation of the phytopreparation, validation of the production process, quality control and stability testing, all together have resulted in the production of capsules with defined valeric acid content (1 mg valeric acid per capsule). DISCUSSION: The preparation is recommended to relieve the symptoms caused by chronic stress (anxiety, irritability, fatigue, lack of concentration, heart palpitations) and for mild insomnia. CONCLUSION: This paper presents the complete cycle of the production of a phytopreparation on the example of a new herbal sedative--Odoval S capsules.

Attitude towards oneself and others in non-clinical population, depressed and paranoid examinees.

BACKGROUND: The theoretical concept of existential/life positions describes person's basic beliefs about oneself and others. Most of authors on TA postulated that every person has one of four possible basic life positions: I'm OK, you're OK; I'm not OK, you're OK; I'm OK, you're not OK and I'm not OK, you're not OK. The aim of this study was the authentication of Existential positions as theoretical concepts in Transaction Analysis, and it's potential to discriminate clinical from non-clinical examinees, and paranoid from depressive examinees within the clinical population. SUBJECTS AND METHODS: The research conducted was co-relational. The sample belongs to the convenience sample type, and comprised 200 examinees, 100 from the non-clinical and 100 from the clinical population of adults. RESULTS: The results of the research confirm a statistically significant difference between the non-clinical and clinical part of the sample in the examined theoretical concept. The "I am not OK" existential position is more expressed in the clinical part of the sample. The differences between the examinees with depressive and paranoid disorders indicate that the examinees with the depressive disorder are more likely to express the "I am not OK, you are OK" and "I am not OK, you are not OK" Existential position. CONCLUSION: In general, we can infer that the assumptions which the research was aimed at testing received partial validation. Examinees from the clinical part of the sample have a statistically significantly higher score at the position "I am not OK". Examinees with depressive characteristics have a more pronounced "I am not OK, you are not OK" position.

[Reaction time in relation to duration of heroin abuse].

INTRODUCTION: Consequences of heroin abuse include organic damage of cerebral structures. The level of impairments is in a direct and positive relation with the length of heroin abuse. OBJECTIVE: The aim of this research was the evaluation of the reaction time with heroin addicts with different length of substance abuse. RESEARCH METHOD: 90 examinees were divided into three groups with relation to the length of heroin abuse. Data collection included a questionnaire referring to socio-demographic and addictive characteristics. A specially designed programme was used for the evaluation of reaction time to audio/ visual signal. RESULTS: In relation to the reaction time as overall model, the difference between examinees with different length of heroin abuse can be found on the marginal level of significance (F = 1.69; df = 12; p = 0.07). In visual modality, with the increase of length of heroin abuse leads to a significant prolongation of simple (the first visual sign: F = 3.29; df = 2; p = 0.04) and choice reaction time (the second visual sign: F = 4.97; df = 2; p = 0.00; the third visual sign: F = 3.08; df = 2; p = 0.05). Longer heroin consumption also leads to the prolongation of the simple (the first auditory task: F = 3.41; df = 2; p = 0.04) and the complex auditory reaction time (the second auditory task: F = 5.67; df = 2; p = 0.01; the third auditory task: F = 6.42; df = 2; p = 0.00). CONCLUSION: Heroin abuse leads to the prolongation of both simple and choice reaction time in visual as well as auditory modality. The average daily dose of opiates was the most important predictor of the abovementioned cognitive dysfunction.

The effect of heroin on verbal memory.

BACKGROUND: As a result of long-term heroin abuse we can see impairment of cerebral structures, that leads to specific psychopathological and neuro - physiological deficits in the cognitive and connative areas. There is a positive correlation between the mentioned deficits and the duration of heroin abuse. The memory is a cognitive function highly sensitive to toxic effects of opiates. The aim of this study was to establish the psychiatric and psychological consequences of heroin abuse, in the sense of verbal memory deficits, and the specific relation between mentioned deficits with the duration of abuse. SUBJECTS AND METHODS: The research was devised as a prospective study, including ninety heroin addicts, divided into three groups, based on the abuse duration. The following instruments were used for data collecting: questionnaire, with basic social-demographic and addictive characteristics of subjects and Rey Test of Verbal Learning, a neuropsychological test for verbal memory estimation. RESULTS: Only the examinees who have abused heroin for less than a year obtained scores within the domain of the expected performances within the part of the test which relates to the direct verbal memory, as well as, the part of the test that relates to delayed verbal memory. With regard to the mentioned criteria, the difference between examinees with different length of opiates abuse is statistically important (direct memory: F=2.706; p=0.063, delayed memory: F=2.538; p=0.045). With the increase of heroin abuse length the number of examinees with a rising learning curve is decreased significantly, and the number of examinees with a flat learning curve is increased (Chi-square=19.589; p=0.003). CONCLUSION: Heroin abuse, lasting longer than one year, is connected with impairment of short-term and delayed verbal memory. The intensity of the mentioned effects is higher with addicts who use a higher daily dose of heroin.

AD/HD in the genesis of conduct disorder--does biopsychosocial approach make sense?

There are numerous theories approaching the source of mental disorders (including conduct disorder) from different perspectives - biological, psychological, social and multifactorial. The question that arises is which theory is to be used to explain the issue. In the interpretation of phenomena in psychiatry, Kecmanovic discusses possibilities of different approaches (biological, psychological, social and biopsychosocial models) and concludes that none of them provide a complete solution as to how to approach different disorders. The question, therefore, is how to proceed? Although according to Kecmanovic, the biopsychosocial model, as Engel has formulated it, "provides only ingredients not a prescription", it is our opinion that it indeed does not need to provide prescriptions- it is sufficient if it indicates the necessary ingredients. The prescription itself is to be found in novel scientific disciplines, in particular neuropsychology and epigenetics. Gilbert, on the other hand, points out that the bio- psychosocial approach is holistic, and more than that. "The bio psychosocial approach addresses the complexity of interactions between different domains of functioning and argues that it is the interaction of domains that illuminates important processes" e.g. a hierarchical dimension of the model as one and development as another dimension provide the basis for a comprehensive perspective on psychiatric disorders, in this case of AD/HD as a risk factor for conduct disorder.

Non-atherosclerotic arteriopathy as the cause of ischemic stroke among young adults.

The study comprised 100 ischemic stroke patients of both sexes aged 15-45 years who were treated at the Clinic of Neurology of the Clinical Center of Vojvodina in the period January 2001-September 2004. All study subjects were divided into three age groups: 15-25, 26-35 and 36-45 years. Sex, age and risk factors for cerebrovascular disease were determined in all patients. Diagnostic procedures applied in all patients included brain computed tomography and/or magnetic resonance imaging, routine laboratory tests, Doppler imaging of extra and endocranial blood vessels and coagulation tests. Contrast and/or transesophageal echocardiography, immunological blood assays, magnetic resonance angiography and/or computed tomography angiography and/or conventional angiography, thrombophilia markers, antiphospholipid antibodies and toxicological examination, etc. were performed in selected patients. Non-atherosclerotic arteriopathies were found in 8% of all study subjects, and were the most frequent cause of stroke in the age group 15-25. Carotid artery dissection was the most frequent diagnosis overall, found in 6% of all patients. Fibromuscular dysplasia and systemic vasculitis were diagnosed in one patient each. Moyamoya disease, Takayasu disease, infectious and isolated vasculitis of the CNS were not found in our patients.

Psychiatric consequences of stress after a vehicle accident.

BACKGROUND: Vehicle accidents are a common cause of disease and death among people over 30 years of age. Essentially, reaction to stress due to the vehicle accident does not differ from the reaction to other stress factors. There are still no uniform viewpoints about the kind of sequels and their percentage representation after vehicle accidents. SUBJECTS AND METHODS: The research was provided as a prospective study, included 150 subjects who had vehicle accident minimum 2 years prior to the examination. A questionnaire adjusted to the needs of the research and a battery of psychological tests was used. RESULTS: Affective disorders occurred in 35.33% of subjects, 65% of persons suffer from travel anxiety, 9% of the total number of examinees doesn't drive any more, 65% have somatisational dysfunctions of the vegetative nervous system, while the posttraumatic stress disorder is present in 36% of subjects. CONCLUSION: In 87.4% of persons psychiatric consequences last over two years. Long term consequences in 60% of subjects occur as a combination of multiple psychiatric disorders, so the posttraumatic stress disorder and affective disorders never occur one at a time.

[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.

[Family dysfunction in adolescents with suicidal behavior and in adolescents with conduct disorders].

INTRODUCTION: The period of life known as adolescence generally refers to transition from childhood to adulthood. Adolescents' progress toward autonomy involves remaining connected with, as well as separated from parents. Young people and their parents usually have mixed feelings about adolescent autonomy and attachment. An estimated 50% of children born in the 80-s have spent part of their developmental years in single-parent households. Divorce is almost always a stressful event in children's lives. Youthful suicide rate has increased dramatically and is the third leading cause of death among 15-19 year olds. Conduct disorder is one of the mostfrequently diagnosed conditions in adolescents. Suicidal adolescents and adolescents with conduct disorder are much more likely than their peers to have grown up in disrupted, disorganized homes with lack of attachment between parents and their children. MATERIAL AND METHODS: This prospective study was carried out during 2002, 2003, and 2004. The research included 60 adolescents treated at the Center for Child and Adolescent Psychiatry in Novi Sad, 30 with diagnosed conduct disorder and 30 with suicidal behavior. RESULTS: Along with other kinds of distress, suicidal adolescents have experienced an escalation of family problems a few months prior to attempted suicide. DISCUSSION: Divorce and life in singe-parent households is almost always a stressful period in children's lives. Conduct disorder and suicidal behavior represent a desperate cryfor help. Conclusion Most adolescents in both groups live in single-parent households. These young people have frequently passed into adolescence with little reason to feel that they could rely on their parentsfor support, or on their home as a place of sanctuary.