Mediterranean Diet Adherence, Physical Activity, and Advanced Glycation End Products in Complex PTSD: A Comprehensive Examination of Lifestyle and Cardiovascular Risk in War Veterans.

As accumulated evidence suggests that individuals with post-traumatic stress disorder (PTSD) encounter earlier and more frequent occurrences of cardiovascular diseases, the aim of this study was to ascertain the differences in lifestyle and cardiovascular risk between PTSD and complex PTSD patients. We enrolled 137 male war veterans with PTSD (89 had complex PTSD). The diagnosis was established based on 11th revision of International Classification of Diseases (ICD-11), and cardiovascular risk was estimated by the measurement of advanced glycation end products. Adherence to Mediterranean diet (MD) was lower in the complex PTSD group (2.2% vs. 12.5%, p = 0.015). Accordingly, patients with complex PTSD had lower healthy lifestyle scores in comparison to PTSD counterparts (50.6 ± 9.7 vs. 59.6 ± 10.1, p < 0.001), and a positive association was noted between MD adherence and a healthy lifestyle (r = 0.183, p = 0.022). On the other hand, differences were not noted in terms of physical activity (p = 0.424), fat % (p = 0.571) or cardiovascular risk (p = 0.573). Although complex PTSD patients exhibit worse adherence to MD and lower healthy lifestyle scores, these differences do not seem to impact physical activity, body composition, or estimated cardiovascular risk. More research is needed to clarify if this lack of association accurately reflects the state of the PTSD population or results from insufficient statistical power.

Attitudes on Psychedelics in a Sample of Croatian Mental Health Professionals: A Cross-Sectional National Survey Study.

For some time now, there has been an increased interest in psychedelics among scientists and mental health experts. Given that experts introduce therapy and advise patients, it is important to know their views. Therefore, the aim of our research was to examine and compare the attitudes of psychiatrists and psychologists toward psychedelics. We were interested in how they are formed and what is the role of personality in that process. We included 218 respondents, of which 92 were psychiatrists and 126 were psychologists. Attitudes toward psychedelics were examined using the Attitudes on Psychedelics Questionnaire. We used the Big Five Inventory to examine personality traits. On the Legal Use of Psychedelics subscale, it was shown that psychiatrists have more negative attitudes toward psychedelics (p = .033). Higher Openness (ß = 0.184, p < .001) and lower Conscientiousness (ß = -0.144, p = .009) contribute to positive attitudes toward psychedelics, as well as previous lifetime experience with psychedelics (ß = 0.411, p < .001) and younger age (ß = -0.278, p < .001). In conclusion, we can say that mental health professionals are open but also wary of psychedelics. Openness motivates them to learn. For this reason, additional education could have an impact on the attitudes of psychiatrists and psychologists and prepare them for the practical use of psychedelics.

The reflective measurement model of adherence to non-pharmaceutical interventions (NPIs) in accordance with normalization process theory (NPT) in coherent and convenient social subgroups: PLS-SEM analysis.

BACKGROUND: Non-pharmaceutical interventions (NPIs) decrease COVID-19 transmission. Reliability and validity of adherence to NPIs in accordance with normalization process theory (NPT) in coherent and convenient social subgroups using reflective measurement model assessment has not been evaluated. METHODS: In February 2021, a sample of medical students and people with substance use disorders in treatment as coherent (based on continuous probability distribution) vs. convenient groups (based on convenience, not equal probability) composed of travellers and COVID-19 suspected persons from Split-Dalmatia County (SDC) (n = 656) in the Mediterranean completed self-administered surveys. Partial least squares structural equation modelling (PLS-SEM) was used to measure reflective model assessment of adherence to NPIs according to NPT. RESULTS: PLS-SEM reflective model assessment provided two-group specific factors in inverse relationships which determined adherence to NPIs with excellent goodness-of-fit [χ2 = 1.292, df = 1; P = 0.297, CFI = 1, TLI = 0.997, RMSEA = 0.011 (90% CI 0-0.105), RMSEA P = 0.604, SRMR = 0.008, Hoelter CN (α = 0.05) = 2322.757]. Significant negative factors covariance estimate (-0.716) revealed an inverse relationship between first (adherence to NPIs and internal locus of control (LoC) (0.640)) and second factor; young adulthood age (≤25) and highest level of education (1362). As the first factor increased the second tended to decrease. LoC is expected potential mechanism by which sex (MLsex = -0.017, SE = 0.007, P < 0.016) and belonging to coherent subgroups (MLgroup = -0.008, SE = 0.003, P = 0.015) can produce indirect effect of adherence to NPIs. CONCLUSIONS: Coherent subgroups had a more pronounced tendency toward integration of NPIs in everyday life. Group factors that facilitate the normalization were higher educated younger adults with a tendency toward external LoC.

Mental Health of Patients Hospitalized Due to Covid-19.

Objective: The COVID-19 pandemic has imposed numerous challenges on the mental health of the population of each affected country. The mental health of patients hospitalized due to COVID-19 was particularly at risk. The goal of this research was to examine the occurrence of mental disorders in such patients and what were the risk factors for poorer mental health during hospital treatment for COVID-19. Method: We included 135 subjects treated for COVID-19 who were discharged during January 2022. We collected their sociodemographic data as well as data on somatic comorbidities and treatment during hospitalization. We monitored how many patients were hospitalized with a psychiatric diagnosis and therapy, and how many of them started using psychotropic drugs during hospitalization. Those data were recorded both at the time of discharge and again one year later. Results: Statistical analysis showed that the number of patients using psychotropic drugs increased 4x (n=11 (8.1%) at admission vs. n=44 (32.6%) in hospital) during hospital treatment due to COVID-19. There was an increase in the use of all psychotropic drugs except for antidepressants; specifically, there was a 3.3x increase in treatment with anxiolytics (5.2% at admission vs. 17.0% in hospital), a 3.4x increase in treatment with antipsychotics (5.2% vs. 17.8%), and an 8x increase in treatment with hypnotics (0.7% vs. 5.9%). Their use decreased close to baseline after discharge. Conclusions: Our research showed that hospitalization due to COVID-19 leads to deterioration of mental health. We assume that there is a fear of death in the background, which can be well explained by the "landscape of fear" theory.

Rehospitalization Rates Among Patients with Psychotic Disorders During Covid-19 Pandemic: Oral Versus Long-Acting Injectable Antipsychotics.

Objective: The superiority of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics is often emphasized, even in terms of adherence and rehospitaliza-tion rates. As such, LAIs are particularly recommended during the COVID-19 pandemic. The goal of our research was to determine whether there are differences in the number of rehospitalizations in patients treated for schizophrenia, schizophrenia-like disorders, and delusional states (psychotic disorders) with LAI antispychotics versus oral antispychotics. Method: Subjects with schizophrenia, schizophrenia-like disorders and delusional states participated in our retrospective study. 124 subjects were treated with oral anti-psychotics, while 72 received LAIs along with oral antipsychotics. We collected their sociodemographic data and psychiatric history data. Our main outcome measure was the number of rehospitalizations. Results: Statistical analysis showed that the studied groups did not differ according to sociodemographic parameters, except that in the group of patients with LAIs there was a significantly higher percentage of men (65 (52.4) vs 50 (69.4), p=0.029)). Also, the groups do not differ according to the psychiatric history data. There is no difference in the duration of the current hospitalization nor in the composition of the patients, considering the order of the current hospitalization. The difference in the number of rehospitalizations is not significant neither in the first year of follow-up (p=0.144), nor in the second (p=0.142), nor after two years of follow-up (p=0.083). Conclusions: Our research has shown that there is no difference in the number of rehospitalizations in patients with schizophrenia, schizophrenia-like disorders and delusional states, considering whether they take oral antipsychotics or they also take LAIs along with them. We can therefore conclude that it is particularly important to work on improving patient adherence. We must make psychiatrists aware that the pandemic, like other threats, can be our ally in improving adherence ("perceived threat as a health belief").

Knowledge, Attitudes, and Screening for Obstructive Sleep Apnea and Diabetes Mellitus among War Veterans Seeking Treatment of Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders. However, we should not neglect the somatic aspects of PTSD. Associations with cardiovascular diseases (CVD) are particularly concerning because PTSD was associated with an even 53% higher risk for CVD. This study aimed to analyze the prevalence of several CVD risk factors, especially diabetes mellitus among PTSD patients divided into three groups according to obstructive sleep apnea (OSA) risk stratification (low, intermediate, and high). This cross-sectional study included one hundred male PTSD veterans. The mean age was 53 (40-67) years. The estimated OSA risk was 95% for the whole cohort, and 53% were in the high-risk group. Median HbA1c was 5.6 (4.6-10)%. The hemoglobin A1c (HbA1c) levels showed that 34 patients were in the prediabetes group, and 20 of them fulfilled the criteria for diabetes. However, only 13 of them were aware of their previous diagnosis of diabetes mellitus. In testing knowledge about diabetes, 62% and only 23% of patients knew the correct definition of HbA1c and level of fasting plasma glucose, respectively. Diabetic patients had insufficient knowledge about diabetic complications and treatment. A higher level of PTSD symptoms in veterans was associated with a higher prevalence of OSA. The results strongly support further research and education into early detection of CVD risk factors associated with PTSD.

Violence without a Face: the Analysis of Testimonies of Women Who Were Sexually Assaulted During the War in Croatia and Bosnia and Herzegovina.

BACKGROUND: This study examined testimonies of women who were sexually assaulted multiple times by multiple unknown offenders. In these testimonial narratives, it is possible to detect specific modalities of traumatic event expression. This expression lacks any spatial, temporal, auditory or emotional determinants of the event. SUBJECTS AND METHODS: These fourteen women (out of 17) were imprisoned and forcefully isolated in detention camps or private houses in the occupied territories of Croatia and Bosnia and Herzegovina, during the war. At the same time, some of these women were raped by the offenders that were previously known to them. The average length of detention was 141 days among the seventeen victims (range of 7 to 395 days), while the average time from the first day of imprisonment to the first day of testimony was 311 days (range of 30 to 889 days). RESULTS: Based on the narrative descriptions of the events acquired from these testimonies, our analysis showed that these expressions differed when the offender was known to the victim, contrasted to the situation when the offender was completely unknown. This finding has a significant implication in victim's testimony at judicial hearings. Specifically, women that were raped by unknown perpetrator(s) were often unable to provide persuasive testimony and their recollection of the events was deemed insufficient for the further prosecution. Testimonies in these cases substantially lacked in vividness and were devoid of visuospatial determinants of the rape event. Consequently, this often resulted in the case's dismissal. CONCLUSION: The unusual and problematic expression of these traumatic memories might indicate that these events were not properly stored in the conceptual form of memory. Ultimately, victims could not make any coherent recollection or reconstruct the cascade of events by using perceptual information. We argue that this could be due to an aberrant mechanism of memory storage and difficulties that emerge on the level of sensory input. This problem needs to be further examined and correspondingly accounted for since it can exert significant influence on judicial outcomes in the domain of sexual assault cases worldwide.