Catatonic schizophrenia has a shorter pre-hospitalisation interval than other types of schizophrenia.

The time elapsed between the first onset of symptoms and the onset of first hospitalisation was analysed in 355 participants diagnosed with paranoid, simple, hebephrenic and catatonic schizophrenia and shizoaffective disorder. The real onset of the disease was assessed from interviews with reliable relatives and by reviewing medical records in general practices and out-patient psychiatric services. In 184 patients a family history of schizophrenia was identified. A positive family history was found to significantly increase the interval preceding first hospitalisation in all analysed types, except in catatonic schizophrenia. Possible reasons causing this prolongation are discussed, as well as repercussions of the results to studies using age of first hospitalisation as the leading indicator.

Comorbidity of posttraumatic stress disorder and alcohol dependence in displaced persons.

AIM: To investigate in displaced persons a) the prevalence rate of current posttraumatic stress disorder (PTSD) and alcohol dependence; b) the relationship of alcohol dependence and current PTSD; and c) trauma exposure in relation to alcohol dependence comorbid to PTSD. METHODS: A group of displaced persons (157 men and 211 women) was interviewed using structured clinical interview based on DSM-III-R criteria for diagnosing PTSD and alcohol dependence, Watson's PTSD Questionnaire, and CAGE Questionnaire. RESULTS: Men showed higher prevalence rate of a current PTSD (50.3% of men vs. 36.5% of women, p=0.011), alcohol dependence (60.5% of men vs. 8.1% of women, p<0. 001), and alcohol dependence comorbid with PTSD (69.6% of men vs. 11. 7% of women, p<0.001). The rate of alcohol dependence increased in relation to current PTSD in men but not in women. Comorbidity of alcohol dependence and PTSD in women was influenced by alcohol-related problems before the war, whereas in men it was not influenced by any of the pre-war variables. The highest number of traumas was experienced by the displaced persons with a current PTSD only, followed by those with PTSD and alcohol dependence. The lowest number of war traumas was experienced by displaced persons with alcohol dependence, but without current PTSD. CONCLUSION: War traumas may have a role in the development of alcohol dependence in displaced men with current PTSD. The number of war traumas had a strong effect on the development of PTSD. Sex is a relevant factor in studying comorbidity of current PTSD and alcohol dependence.

Psychotic symptoms and comorbid psychiatric disorders in Croatian combat-related posttraumatic stress disorder patients.

AIM: To investigate the prevalence rate of post-traumatic stress disorder (PTSD) comorbid psychiatric disorders and to explore psychotic symptoms in patients with combat-related current PTSD. METHOD: The sample included Croatian war veterans (N=41) who were hospitalized at the University Department of Psychiatry of the Vrapèe Psychiatric Hospital during the 1995-1996 period and fulfilled the DSM-IV criteria for the current and chronic PTSD. The Schedule for Affective Disorder and Schizophrenia (SADS-L) was applied for the assessment of current and lifetime psychiatric disorders. Only three subjects had a prewar Axis I psychiatric disorder. One third of the patients met the criteria for personality disorder. RESULTS: After severe combat trauma, the majority of PTSD patients (33/41) had at least one comorbid psychiatric diagnosis on Axis I. In those with personality disorders the most frequent was alcohol dependence, whereas in those without personality disorders it was major depressive disorder. Psychotic symptoms occurred in 8 out of 41 PTSD patients. None of them had a primary psychotic disorder or a personality disorder. In all the patients, psychotic symptoms were different from flashbacks. They were symbolically related to the trauma and resistant to antipsychotic treatment. Psychotic symptoms were associated with depression in 5 out of 8 patients with psychotic symptoms. CONCLUSION: Severe and prolonged combat trauma may be followed by the co-occurrence of PTSD and psychotic symptoms, forming the atypical clinical picture of PTSD.

Platelet monoamine oxidase activity, ego strength, and neuroticism in soldiers with combat-related current posttraumatic stress disorder.

AIM: To assess possible differences in platelet monoamino oxidase-B (MAO-B) activity, ego strength, and neuroticism in combat-experienced soldiers with or without current posttraumatic stress disorder (PTSD). METHOD: The soldiers with current PTSD (N=36) and a control group of 34 healthy soldiers were matched in combat experience, time passed between combat experience and the study, demographic variables (age, marital status, education), and smoking status. Platelet MAO-B was assayed fluorometrically, ego strength was measured by the Croatian version of the Ego Identity Scale, and neuroticism by the N-scale from Eysenck's EPQ-R questionnaire. RESULTS: Soldiers with combat-related current PTSD had lower platelet MAO-B activity than the control group (9.1+/-3.9 vs. 11.9+/-4.0; p<0.05), as well as lower ego-strength (86.3+/-8.3 vs. 108.6+/-13.4; p<0.05) and higher neuroticism (23.5+/-13.2 vs. 5. 9+/-4.7; p<0.05). There was no association of ego strength or neuroticism with platelet MAO-B activity. CONCLUSION: Ego identity strength and emotional stability are associated with successful coping with combat trauma. The involvement of platelet MAO-B activity in biological basis of ego strength and neuroticism could not be demonstrated.

Posttraumatic stress disorder and platelet serotonin measures.

The role of serotonin (5HT) in the pathophysiology of posttraumatic stress disorder (PTSD) has been suggested by the overlap in clinical symptoms between PTSD and psychiatric conditions in which a serotonin dysfunction is implicated, as well as by the therapeutic efficiency of 5HT-related drugs (antidepressants, selective serotonin reuptake inhibitors and monoamine oxidase inhibitors) in alleviating symptoms in PTSD. In the present study, the blood platelet, which has been proposed as a peripheral model for the central serotonergic neurons, has been used to search for alterations in 5HT mechanisms in PTSD. Platelet serotonin level and kinetics of serotonin transporter and monoamine oxidase (MAO-B) were assessed in 63 combat-related PTSD patients and 43 sex and age-matched control subjects. A significant reduction in maximal velocity of platelet MAO-B (approx. 30%), with no changes in the enzyme affinity was observed in our patient sample. Conversely, no alterations in kinetic parameters (V(max), K(m)) of platelet serotonin transporter, as well as in platelet 5HT level, were found in the PTSD group.

Personality dimensions and psychiatric treatment of alcoholics' wives.

AIM: To investigate the basic personality dimensions of the wives of alcoholics in comparison to the wives of non-alcoholics, and to compare these two groups according to psychiatric treatment frequency. METHOD: The group of alcoholics' wives (N=100) was compared to a group of non-alcoholics' wives (N=90). The groups were identical with respect to their age, working and marital status. Eysenck Personality Questionnaire was used for measuring the main personality dimensions. A structured psychiatric interview based on ICD-10 and DSM-III-R, and self-assessment of behavior before marriage (extraverted vs. introverted) were also used. RESULTS: The wives of alcoholics were less extraverted than the wives of non-alcoholics. There were no differences in neuroticism and psychoticism. According to the self-assessment of their behavior before marriage, wives of alcoholics also manifested less extraverted behavior before marriage. The wives of alcoholics were psychiatrically treated more often during their marriage than the wives of non-alcoholics. Moreover, the group of the wives of non-alcoholics had fewer psychiatric treatments during than before marriage. CONCLUSION: The wives of alcoholics were less extraverted than the wives of non-alcoholics, but they did not differ in two other main personality dimensions, neuroticism and psychoticism. More psychiatric treatments during marriage of the wives of alcoholics can be interpreted in accordance with the "stressed wife" theory.