Personality differences in patients with and without gallstones.

OBJECTIVE: Presence of gallstones is associated with a range of risk factors that have previously shown associations with personality traits. Our aim was to assess the differences in personality traits between the patients with and without gallstones. METHODS: This study used a case-control design with 308 participants from the general population, 68.2% female, mean age 49.2 (SD 9.24) years, of whom 154 (50%) participants had asymptomatic gallstones. Personality was assessed with the Temperament and Character Inventory - Revised - 140 (TCI-R-140) and depression with the Center for Epidemiological Study of Depression Scale (CESD). Cut-off ≥16 on the CES-D was used as an exclusion criterion. Subjects were also checked for metabolic risk factors and sociodemographic characteristics. RESULTS: The group with gallstones had significantly more pronounced metabolic risk factors and higher prevalence of smoking and alcohol usage in comparison with the group without gallstones. This group also exhibited higher temperament dimension Harm avoidance (HA) and lower character dimension Self-directedness (SD). Metabolic variables differed based on character dimension Cooperativeness (CO), smoking based on temperament dimensions Novelty seeking (NS) and HA, and alcohol usage on dimension NS within the gallstones group. In the logistic regression, controlled for smoking, alcohol usage and metabolic variables, temperament dimension HA was shown to be a significant predictor of the presence of gallstones. CONCLUSION: Our findings indicate that personality may be associated with the presence of gallstones. Future longitudinal studies addressing the complex interplay of personality traits, psychological mechanisms and the associated behavioral, metabolic and neurobiological factors, are needed.

The Impact of Long-acting Paliperidone in Reducing Hospitalizations and Clinical Severity in Recent Onset Schizophrenia: A Mirror-image Study in Real-world Clinical Setting.

OBJECTIVE: Schizophrenia is a debilitating disease that disrupts the lives of many affected individuals and exerts a toll on the health system. Only few studies assessed once-monthly injectable formulation of paliperidone palmitate (PP-1M) and other long-acting antipsychotics in recent onset schizophrenia (ROS). To evaluate whether PP-1M is efficacious in reducing frequency and length of hospitalizations and psychosis symptom severity in patients with ROS. METHODS: This mirror-image study included 112 patients, suffering from ROS admitted in a psychiatric ward and successively treated with PP-1M for 1-year. Other psychotic disorders were excluded. We collected socio-demographic data of all subjects included, number and days of hospitalization, as well as Clinical Global Impression-Severity scale (CGI-S) and Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation and after 1-year of PP treatment. RESULTS: After 1-year PP-1M treatment, mean scores of both CGI and CRDPSS significantly decreased (p < 0.001), as well as the mean number of hospitalizations (p = 0.002) and total hospitalization days (p < 0.001) in comparison with those of the previous year. CONCLUSION: Our results suggest that PP-1M can be considered as an important therapeutic option in patients with ROS. Its use led to a meaningful reduction in the patient's use of hospital services, as well as a significant clinical improvement of psychotic symptoms in our sample.

Comorbid Depression and Suicide Ideation in Patients with Combat-Related PTSD: The Role of Temperament, Character, and Trait Impulsivity.

BACKGROUND: War veterans with PTSD have a high chance of developing major depressive disorder (MDD) at some point, while they can also exhibit increased suicidal tendencies. The primary goal of this research was to investigate whether personality dimensions, including temperament, character, and trait impulsivity, were associated with comorbid MDD, as well as with suicidal ideation in psychiatric patients suffering from combat-related PTSD. SUBJECTS AND METHODS: The sample consisted of 148 Croatian male war veterans (mean age 49.53 years) treated for PTSD at the National Center for Psychotrauma, Department of Psychiatry, University Hospital Center Zagreb. Fifty-one (34%) of them met ICD-10 diagnostic criteria for current or lifetime MDD, while 97 (66%) were diagnosed with PTSD alone. All the participants were assessed with the M.I.N.I. diagnostic interview and they completed the following battery of self-report instruments: the Beck Depression Inventory-Second Edition (BDI-II), the Suicidal Behaviors Questionnaire-Revised (SBQ-R), the Temperament and Character Inventory-Revised (TCI-R), and the Barratt Impulsiveness Scale-11 (BIS-11). RESULTS: Comparisons between the two clinical groups showed that PTSD+MDD patients were more suicidal and differed with regard to temperament dimensions Harm Avoidance, Reward Dependence and Persistence, character dimension Self-Directedness, and trait impulsivity. In three multivariate regression analyses, it was revealed that character dimension Cooperativeness as well as trait impulsivity were unique predictors of suicidal ideation, while controlling for the influence of sociodemographics, length of treatment and comorbid depression. CONCLUSIONS: Combat-related PTSD patients with comorbid depression exhibit increased suicide thoughts and different personality profiles in comparison with those suffering from PTSD alone. Character dimension Cooperativeness and trait impulsivity seem to be uniquely predictive of suicide ideation in this population. Elucidation of individual psychological factors that increase the risk of MDD and suicidal tendencies in war veterans with PTSD may facilitate more effective prevention and treatment methods.

The prevalence and psychosocial correlates of suicide attempts among inpatient adolescent offspring of Croatian PTSD male war veterans.

Despite evidence that children of male war veterans with combat-related posttraumatic stress disorder (PTSD) are at particularly high risk for behavior problems, very little is currently known about suicidal behaviors in this population of youth. This study aimed to examine the prevalence and psychosocial correlates of suicide attempts among psychiatrically hospitalized adolescent offspring of Croatian male PTSD veterans. Participants were psychiatric inpatients, ages 12-18 years. Self-report questionnaires assessed demographics, suicide attempts, psychopathology, parenting style, and family functioning. The prevalence of suicide attempts was 61.5% (65.2% for girls and 58.0% for boys). Internalizing symptoms, family dysfunction, lower levels of maternal and paternal care, and paternal overcontrol were significantly associated with suicide attempts. Our findings suggest that suicide attempts are common among inpatient adolescent offspring of male PTSD veterans and that interventions targeting both adolescent psychopathology and family relationships are needed for adolescents who have attempted suicide.

Psychobiological model of personality and psychopharmacotherapy outcomes in treatment of depression and schizophrenia.

In distinguishing why some patients respond and other do not respond to treatments arraised the clinically very important body of research considering weather patients' personality characteristics might predict outcomes of pharmacotherapeutic treatment. Personality can be a predictor of a psychiatric disorder either owing to their common genetic background or because it enhances exposure of the subject to environmental risk factors. The results of the studies using psychobiological model are reviewed. The studies show that personality temperament dimension Harm Avoidance and character dimension Self-directedness predict outcomes of the pharmacological treatment of depression, but the result for other psychiatric disorders are sparse. The studies are not straightforward in recommendations for treatment choice dependent of personality dimensions.

Quality of life of key caregivers of schizophrenia patients and association with kinship.

INTRODUCTION: Reports on the quality of life (QOL) of family caregivers of schizophrenia patients are uncommon. Relations of different degree of kinship to caregivers' QOL are unexplored, but may be relevant. The purpose of this study was to assess the subjective QOL of caregivers of stable outpatients with diagnosis of schizophrenia compared with controls, and to assess factors associated with QOL in this population. METHODS: Responses of 138 schizophrenia outpatient' family caregivers to the Quality of Life, Enjoyment and Satisfaction Questionnaire (QLESQSF) were compared with those of a sex- and age-matched control group. Patients were assessed with the Positive and Negative Symptom Scale (PANSS) and the Global Assessment of Functioning (GAF) and data were collected for kinship relationship and hospitalization. RESULTS: Group of caregivers had significantly lower QOL compared with controls (t=11.347; df=271; p=0.0001). Caregivers' QOL correlated significantly with their age and differed according to the degree of kinship and marriage status. ANCOVA, with age as covariate, performed to asses the differences in QOL according to kinship, showed that parents and own children had significantly lower QOL than patients' siblings who were also caregivers. CONCLUSION: QOL of the schizophrenia patients' caregivers is lower in comparisons to controls. It depends on the degree of kinship and caregivers' age. Parents and own children have lower QOL than siblings. Psycho-educational intervention programmes should target specific needs of the family as a whole, depending also on their age and kinship relationship.

Outpatient treatment of children and adolescents with antidepressants in Croatia.

OBJECTIVE: This study is aimed to determine the prevalence and patterns of antidepressants prescription in outpatient setting in Croatia. METHODS: Retrospective analysis of outpatient visits to child psychiatrists by persons aged 18 and younger that included prescription of antidepressants during the year 2010. Antidepressant prescription data were identified by medication class, drug entity and were analyzed in relation to age group, gender, psychiatric diagnosis. RESULTS: Antidepressants were prescribed to 139 youths (0.24‰), significantly more to adolescents than pre-adolescents and for the treatment of depressive disorders in females, and mixed disorders of emotions and conduct in males. Sertraline was the most prescribed antidepressant for the treatment of major depressive disorder, followed by fluvoxamine and tianeptine. Fluvoxamine was the most prescribed antidepressant for the treatment of anxiety disorders and mixed disorders of emotions and conduct. Off-label prescribing of antidepressants was found in 85.6% of young patients. CONCLUSIONS: This study found considerably lower prevalence and higher off-label rate of antidepressant prescriptions to young people in Croatia to that in other European Countries and in the United States. Selective serotonine reuptake inhibitors comprise most of the antidepressant medications prescribed to young people, reflecting trends in the developed countries.

Temperament, character, and quality of life in patients with schizophrenia and their first-degree relatives.

The aim of this study was to investigate the associations between the temperament, character dimensions, and quality of life (QOL) of patients with schizophrenia; their first-degree, nonaffected relatives; and healthy control subjects. One hundred twenty patients, the same number of first-degree relatives, and the same number of control subjects were assessed using the Temperament and Character Inventory and the Quality of Life Enjoyment and Satisfaction Questionnaire. Patients were also assessed using the Positive and Negative Syndrome Scale. Patients and relatives had a significantly lower QOL than control subjects, controlled for temperament and character dimensions. Patients scored significantly higher than control subjects in harm avoidance and self-transcendence and lower in novelty seeking and self-directedness. First-degree relatives had lower results for novelty seeking and scored higher on self-transcendence than control subjects. Harm avoidance, self-directedness, and self-transcendence were the dimensions of Temperament and Character Inventory shown to be the most significant predictors of QOL. Psychopathology and age were also significant predictors of QOL. Our understanding of an individual patient's QOL must include personality evaluation.

Relations of internalized stigma with temperament and character in patients with schizophrenia.

OBJECTIVE: The aim of the study was to assess the associations between self-stigma and temperament and character dimensions. METHODS: One hundred twenty outpatients with diagnosis of schizophrenia, established with Mini International Neuropsychiatric Interview were consecutively included in the study. Self-stigma was assessed with Internalized Stigma of Mental Illness (ISMI), personality dimensions with Temperament and Character Inventory, and psychopathology with Positive and Negative Symptom Scale. RESULTS: The results showed that higher level of harm avoidance, lower self-directedness, and persistence correlated with ISMI and all its subscales. Self-transcendence correlated with ISMI subscales alienation, discrimination, and stigma resistance. Regression analyses controlling for psychopathology, age, length of illness, and number of hospitalizations revealed that higher level of harm avoidance and low self-directedness predicted internalized stigma. CONCLUSION: The finding suggests that the experience of self-stigma is related to personality dimensions. Interpretations of these findings include the possibility that, irrespective of patients' psychopathology or functional characteristics, experience of self-stigma and its consequences might depend on personality dimensions. Further studies are needed.

Personality and schizophrenia: psychobiological model and its relationship with comorbidity.

Personality interacts with psychosocial variables, psychopathology and coping strategies of patients with schizophrenia. Psychobiological model of personality is important for schizophrenia as temperament dimensions, except dimension Persistence, have been associated with different neurotransmitter systems. Comorbidity of psychiatric and somatic disorders and syndromes is generally associated with dimensions high Harm avoidance and low Self-directedness. Variations in other dimensions may also be important. High Harm Avoidance may represent state vulnerability marker for various psychiatric disorders and is associated with appearance of comorbidity in schizophrenia. High Self-directedness may be protective factor for development of various psychiatric as well somatic comorbidity states.

Problems in the current psychiatry residency training program in Croatia: residents' perspective.

The aim of this study is to evaluate the quality of the current residency training in psychiatry in Croatia using parameters of professional achievements of residents and their subjective evaluations of the residency training that is being offered. 66 residents from 15 Croatian psychiatric hospitals, clinics and wards in general hospitals fulfilled the questionnaire constructed to obtain information about the profile of psychiatry residents in Croatia, parameters of educational quality and evaluation of offered residency training as seen by residents. We interviewed 89% of all residents that had a trainee status in September and October 2006 in Croatia (66 out of 74). Study results indicate that Croatian psychiatry residents are derived from a pool of very good medical students and the majority is engaged in postgraduate studies and research activities and shows high interest in specific psychiatric fields such as psychotherapy and clinical psychiatry. Most of participants are only partially satisfied with the residency training that is being offered and feel that most problems reside from the lack of practical psychotherapy, the inefficiency of the mentorship system and the lack of funding resources. The results of this study revealed the major problems of psychiatry residents in Croatia. Following those results, we will perform the study that would include mentors and supervisors from different Croatian psychiatric centers. That could enable the development of specific interventions with aim to improve current residency training in Croatia.