The spectrum of anxiety. From normal - to psychotic.

A review of the different forms of anxiety is presented and the phenomenological and anthropological aspects of different types of anxiety are described. Clinical and neurobiological aspects of anxiety are then discussed, and the relationship of psychosis to anxiety is then described.

Psychosis: what it is and what it is not. Psychiatric diagnosis an an ethical problem.

The different causes of misdiagnosis in psychiatry are reviewed, and the ethical implications of such misdiagnoses are discussed.

Transcranial magnetic stimulation in schizophrenia.

Transcranial magnetic stimulation (TMS) is a non-invasive and painless way of stimulating the neural tissue (cerebral cortex, spinal roots, and cranial and peripheral nerves). The first attempts at stimulating the neural tissue date back to 1896 by d'Arsonval; however, it was successfully carried out by Barker and colleagues in Sheffield, UK, in 1985. It soon became a useful tool in neuroscience for neurophysiologists and neurologists and psychiatrists. The original single-pulse TMS, largely used as an investigative tool, was further refined and developed in the early 1990s into what is known as repetitive TMS (rTMS), having a frequency range of 1-60 Hz. The stimulation by both TMS and rTMS of various cortical regions displayed alteration of movement, mood, and behavior, leading researchers to investigate a number of psychiatric and neuropsychiatric disorders, as well as to explore its therapeutic potential. There is now a large amount of literature on the use of TMS/rTMS in depression; however, its use in schizophrenia, both as an investigative and certainly as a therapeutic tool is relatively recent with a limited but increasing number of publications. In this article, we will outline the principles of TMS/rTMS and critically review their use in schizophrenia both as investigative and potential therapeutic tools.

Electroconvulsive therapy in psychiatric practice: a selective review of the evidence.

Electroconvulsive therapy (ECT) is largely historical but is still in use. Modern psychiatry requires careful selection of patients in whom ECT will be performed. The indications for ECT treatment are limited, and the selection criteria should be strictly followed. The advantages and the disadvantages of the methods are discussed here. Despite the limitations, ECT seems to have real value in selected mental conditions in which it can even be considered a life-saving procedure.

Duration of untreated psychosis and it's effect on the functional outcome in schizophrenia - preliminary results.

OBJECTIVES: A long duration of untreated psychosis (DUP) is associated with a poorer prognosis and with worse functional outcome. The aim of the study was to show that early treatment with antipsychotics in the prodromal phase improves the outcome; to compare outcome in patients with DUP longer than 1 year (group 1) with patients who had received treatment with antipsychotic medication in the prodromal phase of the disease (group 0). SUBJECTS AND METHODS: 87 patients with schizophrenia were included in the retrospective study, 37 patients in group 0 and 50 patients in group 1. Sociodemographic parameters were evaluated, including employment, marital status and educational level. Groups were compared during the acute psychosis of first episode (t1) and at the conclusion of the study (t2). RESULTS: Vocational status was worse in group 1 with a higher degree of unemployment and disability than in group 0 (chi(2)=17.47, df=4, p=0.002) at t2. More than half of the patients in group 1 were on disability benefit as compared to 19% of patients in group 0. At t1 differences were not statistically significant (chi(2)=4.15, df=3, p=0.245). There were more single patients in group 1 during both evaluations. At t1 almost half of the patients in group 0 were married; in group 1 only 18% were married (chi(2)=11.47, df=3, p=0.003). Also at t2 more patients in group 0 were married than in group 1 (chi(2)=8.01, df=3, p=0.046). Significant differences between the groups in achieved educational level were noted only at t1 (chi(2)=9.65, df=3, p=0.022). CONCLUSIONS: Better outcome can be achieved with early antipsychotic treatment in the prodromal phase.

Psychotherapeutic approaches in the treatment of schizophrenia.

The author gives a critical overview of various psychotherapeutic approaches used with persons with schizophrenia and their families. It is emphasized that these approaches are to be used in conjunction with pharmacological treatment and should always be individualized for each patient depending on the phase and severity of illness. Individual psychotherapy, particularly cognitive-behavioural modality, group therapy, and family therapy are described in some detail. Special attention is given to compliance therapy.

Reappearance of catatonia. A case report.

We describe a patient who was ill for more than 15 years. She was treated predominantly as a neurological case because of multiple motor signs. The diagnosis of catatonia was considered at the time when she was hospitalized in a psychiatric hospital after a suicidal attempt. The "therapeutic blindness", which was obviously present during 15 years of her illness, is discussed: the ICD--10 is perhaps misleading regarding this diagnosis while it associates it too tightly only to schizophrenia.

Suicidal ideation in adolescence--an indicator of actual risk?

BACKGROUND: The aim of the study was to assess both the frequency of suicidal ideation and also its link to other risk factors for suicidal behavior in the community population of adolescents. METHOD: In the study, we have used a structured questionnaire for assessing the risk factors for suicidal behavior, and self-assessment scales for measuring depression and self-esteem. The research included 4,692 adolescents aged from 14 to 19 years. The sample is representative of the population of Slovene high school students. RESULTS: The prevalence of suicidal ideation was 44% at anytime in respondent's life, and 10.3% during the recent month, and statistically significantly more frequent in girls than in boys. Suicidal ideation proved to be linked to high level of depression and low self-esteem, and also to the important psychosocial risk factors for suicidal behavior, such as: tendency to react on stress by consuming alcohol, alcohol and substance abuse, frequent conflicts with parents and frequently running away from home, pessimism about the future and self estimation of high probability of suicide in the future. CONCLUSIONS: Suicidal ideation is an important suicide risk factor in adolescence, and requires adequate attention among all other relevant risk factors.

Attitudes towards suicide in Slovenia: a cross-sectional survey.

BACKGROUND: Slovenia has been experiencing a very high suicide rate (30 per 10,000 inhabitants per year or higher) and there are no data on public attitudes towards suicide in Slovenia. AIMS: To identify public attitudes towards suicide in order to expand the basis for prevention. METHODS: A Suicide Attitudes Questionnaire (SUIATT) was sent to a representative sample of adult Slovenian citizens. RESULTS: Some 5.2% of respondents had at least one previous suicidal attempt and 21.6% reported suicidal ideation (SI). More respondents with SI than respondents without SI reported: 1) the suicidal act as deliberated, 2) less importance attached to the mental illness in suicidal behaviour, 3) that a person has the right to commit suicide, and 4) the suicidal act as an act of cowardice. CONCLUSIONS: Results do not allow a general statement whether attitudes towards suicide are permissive or restrictive. However, in the subgroup of respondents with SI we found a tendency towards permissiveness regarding suicide.