Seroepidemiology of Hepatitis E in Selected Population Groups in Croatia: A Prospective Pilot Study.

Hepatitis E has become an emerging infection in many European countries. We analysed the prevalence of hepatitis E virus (HEV) infection in selected population groups in Croatia. Overall HEV IgG seropositivity was 5.6%, while 1.9% participants showed IgM antibodies suggestive of recent infection. No IgM-positive sample was positive for HEV RNA. HEV IgG antibodies were most prevalent in alcohol abusers (8.9%) and war veterans (8.6%), compared with 6.1% among injecting drug users and 2.7% in healthcare professionals. No individual with high-risk sexual behaviour tested HEV seropositive. HEV IgG positivity increased significantly with age from 1.8% to 2.3% in individuals younger than 40 years to 11.3% in individuals older than 50 years (P = 0.023). The mean age of HEV-positive participants was significantly higher than that of HEV-negative participants (50.9 ± 11.8 years versus 41.2 ± 11.8 years, P = 0.008). Seroprevalence rates were significantly higher in residents of suburban and rural areas compared with residents of urban areas (14.5% versus 2.5%, P = 0.003). Additionally, an increasing prevalence of HEV IgG antibodies was observed from 1.8% in participants living in families with two household members to 12.1% in those living with more than four members (P = 0.046). Gender, marital status, educational level, sexual orientation, source of drinking water, history of blood transfusions, surgical procedures, tattooing and travelling were not associated with HEV seroprevalence. Logistic regression showed that living in suburban/rural areas was the main risk factor for HEV seropositivity (OR = 6.67; 95%CI = 1.89-25.0; AOR = 7.14, 95%CI = 1.89-25.0).

Psychiatric patients' experiences in complementary and alternative medicine (CAM), and in religious support--a pilot study.

In the Psychiatric Hospital "Vrapce" an investigation on a 200 patient sample was carried out in the year 2000. The purpose of the investigation was to analyze the examinees' experiences of complementary and alternative medicine (CAM) and religious support. 35.5% of the examinees had had previous experiences of CAM and religious support. The examinees born in towns used CAM methods and religious support significantly more often. The schizophrenic patients used CAM methods and religious support significantly more frequently than the patients with affective and anxiety disorders. Non-significantly more often CAM methods and religious support were utilized by women, examinees between 21 and 30 years of age, persons who graduated from junior college, those who live in cohabitation and patients of Islamic religion. Patients consulted priests most often. Significantly more often patients did not pay for the CAM treatments and religious support and non-significantly more often patients considered CAM therapy and religious support to be successful. Non-significantly more often patients consulted CAM practitioners and religious practitioners without being previously advised by their relatives or friends. Relatives ofthe patients advised them to consult CAM practitioners and religious practitioners significantly more often than the friends of the patients did. Considering the possible missed benefits and harm effects of CAM treatment as well as of the interaction between utilization of CAM methods/religious support and conventional treatment, this problem should be given full attention. Further investigations are required.

The comparison of forensic-psychiatric traits between female and male perpetrators of murder or attempted murder.

The aim of this investigation was to define more clearly specific forensic-psychiatric characteristics of female murder or attempted murder perpetrators. The retrospective method applied was based on the comparison of the data from forensic-psychiatric assessments carried out in the Center for Forensic Psychiatry, Psychiatric Hospital Vrapce, Zagreb, from 1983 to 1997 (including 70 female and 70 male subjects--who committed murder or attempted murder). Compared with men, female offenders were most often in some way emotionally related to their victims, and they were more often victimized themselves before committing the crime. In men alcoholism was a more significant circumstantial factor in the assessment of their accountability. Psychiatric security measures were more often given to male offenders. The intensity of aggression was lower in females than in males. This investigation reveals that there are some sex specific forensic-psychiatric traits of murder or attempted murder perpetrators. The obtained results could be of help in everyday forensic-psychiatric practice, both in assessments and treatment.

[Sertraline in the treatment of premenstrual dysphoric disorder]. / Sertralin u lijecenju predmenstrualnog disforicnog poremecaja.

About 75% of women in reproductive age have some premenstrual changes. It is estimated that 2% to 10% of women experience symptoms severe enough to interfere with their professional or social activities and they meet the DSM-IV criteria for PMDD, premenstrual dysphoric disorder. Benzodiazepines and antidepressants have been shown to be effective treatments for PMDD; GnRH agonists are the second choice. New findings support the opinion that intermittent dosing of some antidepressants, e.g. selective serotonin reuptake inhibitors, is equivalent in efficacy to continuous drug treatment. The aim of the present study was to analyze the characteristics of premenstrual symptoms. In addition, the authors wanted to estimate the efficacy of intermittent sertraline dosing in the treatment of women with premenstrual dysphoric disorder. The study involved women employed in Vrapce Psychiatric Hospital. One hundred and thirty seven of them were examined for the presence of premenstrual symptoms. Seven women with PMDD were included in the treatment with sertraline. Symptoms were monitored with daily reports using the Calendar of Premenstrual Experiences (COPE). Six women completed the study. In three of them, sertraline given during the luteal phase produced significant improvements of premenstrual symptoms.

Psychical difficulties in former prisoners of detention camps.

The war imprisonment is a traumatic experience which is generally considered to have a potential to cause various psychical difficulties, in particular the posttraumatic stress disorder (PTSD). During the aggression on Croatia, several thousands of Croatian soldiers and civilians were held in Serbian detention camps where they were tortured to extent of extreme stress. In this paper, the authors researched psychical effects of stress in former war prisoners. Examinees were observed in three separate groups. The first group was formed of all former prisoners of war (a total of 1458) that went through several medical examinations, including psychiatric one, after their release from detention camps. Examinations were performed at the University Clinic for Infectious Diseases "Dr. Fran Mihaljevic" in Zagreb, in period from November 1991 to September 1992. The second group consisted of 82 former prisoners randomly chosen from a total of 735 prisoners released from the "Sremska Mitrovica" camp in August 1992. The third group contained 37 prisoners from "Manjaca" camp out of 100 invited to the control examination 6 months after their release. A classic psychiatric diagnostic interview was performed in all of the examinees immediately after their release, and in the 2nd and the 3rd group the modified Watson's PTSD questionnaire was also used in addition. In the 2nd group, prisoners were questioned immediately after they were released. Using classical psychiatric interview, a specific psychiatric diagnosis could have been established in 20% cases. Psychiatric symptoms were observed in 30-40% examinees (in 36% of former "Manjaca" camp prisoners). Through the use of Watson's questionnaire, a PTSD diagnosis was established in 85.7% (70 out of 82) prisoners of the 2nd group, and in 27% of the 3rd investigated group of prisoners. Former prisoners examined after release (the 2nd group) showed significantly higher prevalence of PTSD symptoms. All PSTD symptoms were found in more than 50% cases of the 2nd group, while in the 3rd group none of the symptoms were found in more then half of examinees. Results are discussed and one among the direct conclusions is that former prisoners of war, expecting their problems to disappear spontaneously, are unwilling to seek for psychiatric help.

Doctor's oath to secrecy and psychiatric patient.

Doctor's oath to secrecy is in the basics of patient's trust to doctor, which is a prerequisite of successful medical treatment. The authors tried to find the answers to following questions: a) what is the attitude of psychiatric patients, people who ask for psychiatric help, towards revealing facts about their psychical problems, b) how well are they informed about doctor's oath to secrecy and to what extent does their willingness reach in asking compensation on the court in case their secret was revealed, c) what is the frequency of the so called "institutionalized" revealing of secrets. The research was performed on the sample of 100 male psychiatric patients hospitalized at the University Clinic for Psychiatry and additional 100 persons who asked for help using phone service of Center for crisis conditions at the same clinic. The obtained data showed that 41% of hospitalized psychiatric patients wanted to hide their psychical problems, and considerably higher percentage (74%) of patients expect the doctor's discretion about the problem, although the most of them are not convinced that there will actually be one. Not a single patient has expressed willingness to ask for compensation on the court in case of doctor's breaking the oath to secrecy. About the half of the patients are informed about doctor's oath to secrecy (42%), but almost all of them (39% of cases in our total sample) consider it normal that the information about their illness is given to some institution outside their family. Persons that ask for help by phone want to remain anonymous in 43% of cases, and in almost same percentage (41%) they believe that their secrecy is guaranteed. In the concluding paragraphs, the need for constant consideration and actualization of problem of doctor's oath to secrecy in the complex situation of global social and medical progress is stressed.

[Work at the Department of Psychiatry and Psychology at the Medical Headquarters of the Republic of Croatia]. / Rad odjela za psihijatriju i psihologiju pri Glavnom stozeru saniteta Republike Hrvatske.

During the summer 1991, the Ward of Psychiatry and Psychology at the Medical Headquarters, Republic of Croatia has been established as a direct reaction to the cruel war in Croatia. The aim of the Ward is to prevent mental disorders among the individuals participating in the war and among the population of Croatia. Special attention is given to the threatened groups. These are: injured patients, displaced persons, children who have lost one or both of its parents, members of families of persons who have been killed or injured and the others. Treatment doctrines have been provided as well. Besides, a regional psychiatric service which has been formed in accordance with the characteristics of this war which is carried out without a known front, mobile psychiatric groups have also been established. They are made up of volunteers. Particular attention has been directed toward the education and publishing. The first Croatian war psychiatry entitled "Introduction into the War Psychiatry" is going to be published very soon. A program of the so-called veterans hospital has been worked out as well.

Crime committed by schizophrenic patients and suspension of the security measure of treatment and detention.

Schizophrenic patients who commit serious crimes tend to be detained in psychiatric hospitals for longer periods than those who commit minor offences. It is suggested, however, that the duration of detention should hinge instead upon whether the offender continues to constitute a danger to society.