Characteristics of the Group Process in Long-Term Psychodynamic Group Psychotherapy for Patients with Psychosis.

This study aimed to investigate the development of the group process through group climate parameter dynamics during long-term psychodynamic group psychotherapy for 30 outpatients with psychosis. The group process in four groups was monitored using MacKenzie's Group Climate Questionnaire-Short Form (GCQ-S) that was completed by the therapist after each session over the two-year period. The trends of engagement, avoidance and conflict parameters differed between groups, and no clear indicators of the development phases were found. The results suggested that these groups remained in the first developmental phase during the observation period, and highlighted the characteristics of resistance and difficulties in establishing social relations in patients with psychosis.

Quality of life of patients with schizophrenia treated in foster home care and in outpatient treatment.

BACKGROUND: The Sveti Ivan Psychiatric Hospital in Zagreb, Croatia, offers foster home care treatment that includes pharmacotherapy, group psychodynamic psychotherapy, family therapy, and work and occupational therapy. The aim of this study is to compare the health-related quality of life of patients with schizophrenia treated in foster home care with that of patients in standard outpatient treatment. METHODS: The sample consisted of 44 patients with schizophrenia who, upon discharge from the hospital, were included in foster home care treatment and a comparative group of 50 patients who returned to their families and continued receiving outpatient treatment. All patients completed the Short Form 36 Health Survey Questionnaire on the day they completed hospital treatment, 6 months later, and 1 year after they participated in the study. The research also included data on the number of hospitalizations for both groups of patients. RESULTS: Though directly upon discharge from the hospital, patients who entered foster home care treatment assessed their health-related quality of life as poorer than patients who returned to their families, their assessments significantly improved over time. After 6 months of treatment, these patients even achieved better results in several dimensions than did patients in the outpatient program, and they also had fewer hospitalizations. These effects remained the same at the follow-up 1 year after the inclusion in the study. CONCLUSION: Notwithstanding the limitations of this study, it can be concluded that treatment in foster home care is associated with an improvement in the quality of life of patients with schizophrenia, but the same was not observed for the patients in standard outpatient treatment. We hope that these findings will contribute to an improved understanding of the influence of psychosocial factors on the functioning of patients and the development of more effective therapeutic methods aimed at improving the patients' quality of life.

Brain-derived neurotrophic factor as a suicide factor in mental disorders.

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) plays a critical role in brain plasticity processes and serum levels have been demonstrated to be altered in patients with different mental disorder including suicidal behaviour. The objective of this study was to examine the association between serum BDNF levels as a possible peripheral indicator of suicide behaviour in subjects suffering from depression, personality disorders (PDs) and adjustment disorders (ADs) with or without suicide attempt. METHODS: The research included 172 randomly selected individuals suffering from recurrent depressive disorder (RDD; F 33.2), emotionally unstable PD (F 60.3) and AD (F 43.2), with or without attempted suicide according to the criteria of the ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) and 60 phenotypically health control subjects. In the group of patients, 73% subjects took some form of psychopharmacotherapy. Serum BDNF levels were measured by enzyme linked immunosorbent assay. RESULTS: Subjects with PD and AD with suicide attempts had significantly lower serum BDNF levels than those without suicide attempts. In groups of subjects with PD and AD, those taking psychopharmacotherapy had higher serum BDNF levels. In the group of subjects with RDD, there were no differences with respect to suicide attempts or psychopharmacotherapy. Logistical regression analysis was indicated that psychopharmacotherapy and serum BDNF levels statistically correlated with suicide attempts. CONCLUSION: The lower levels of BDNF in subjects suffering from PD and AD with suicide attempts, suggest that the serum BDNF level is a potential marker of suicidal behaviour, independent of mental disorders.

There are no differences in IL-6, CRP and homocystein concentrations between women whose mothers had AD and women whose mothers did not have AD.

A wide range of recent studies have detected inflammation as one of the most influent factors in the appearance and spreading of neurodegenerative brain diseases. We aimed to understand the influence of Interleukin-6 (IL-6), C-reactive protein (CRP) and homocysteine (Hcy) on patients suffering from Alzheimer׳s disease (AD) and on their descendants. Three groups of subjects were analyzed: 55 patients suffering from AD, 51 middle-aged daughters of the patients of the first group, and 53 subjects without positive family history of AD. The results of the conducted research are in accordance with the present scientific knowledge, namely a statistically significant difference for examined parameters has been determined between women suffering from AD and their daughters and control group examinees. No difference was found in serum concentrations of IL-6, highly sensitive C-reactive protein (hsCRP) and Hcy between the groups of the middle-aged descendants of patients with AD and healthy controls without family history of AD. This finding supports the hypothesis that these markers may not play causal role in the development of AD. This is supported by the obtained positive correlation between IL-6 and hsCRP and IL-6 and Hcy in AD patients while there is no such correlation between female subjects with or without a family history of AD.

The effect of atypical antipsychotics on brain N-acetylaspartate levels in antipsychotic-naïve first-episode patients with schizophrenia: a preliminary study.

PURPOSE: To investigate the correlates of a clinical therapeutic response by using the parameters measured by proton magnetic resonance spectroscopy after the administration of atypical antipsychotics. PATIENTS AND METHODS: Twenty-five antipsychotic-naïve first-episode patients with schizophrenia were monitored for 12 months. The patients were evaluated using (1)H magnetic resonance spectroscopy in the dorsolateral prefrontal cortex and Positive and Negative Syndrome Scale, Clinical Global Impression Scale of Severity, Tower of London - Drexel University, Letter-Number Span Test, Trail Making Test A, and Personal and Social Performance Scale. They were administered atypical antipsychotics, starting with quetiapine. In the absence of a therapeutic response, another antipsychotic was introduced. RESULTS: After 12 study months, the N-acetylaspartate/creatine (NAA/Cr) level did not significantly change at the whole-group level. Additional analysis revealed a significant rise in the NAA/Cr level in the study group that stayed on the same antipsychotic throughout the study course (P=0.008) and a significant drop in NAA/Cr in the study group that switched antipsychotics (P=0.005). On the whole-group level, no significant correlations between NAA/Cr values and other scores were found at either baseline or after 12 study months. CONCLUSION: One-year treatment with atypical antipsychotics administered to antipsychotic-naïve patients didn't result in a significant rise in the NAA/Cr ratio. However, a significant rise was witnessed in the study group in which a satisfactory therapeutic response had been achieved with a single antipsychotic administration.

Social functioning of patients with psychotic disorders in long-term psychodynamic group psychotherapy: preliminary research.

BACKGROUND: In recent years, social functioning of patients has increasingly been used as a criterion for assessing therapeutic efficacy of the group psychotherapy. The purpose of this preliminary study was to examine whether social functioning of patients with diagnosed psychotic disorders changes during their participation in psychodynamic group psychotherapy. SUBJECT AND METHODS: The sample consisted of 30 patients involved in the psychodynamic group psychotherapy (PGP), and a comparative group of 30 patients treated only with antipsychotic medication therapy (treatment as usual; TAU). After two years of therapy, the instruments designed for this study (self-assessment and therapist-assessment questionnaire) were applied to examine changes in patient communication in their interpersonal relations, romantic and working functioning, and overall social functioning. The research also included data as to whom patients turned to for help, and the number of hospitalisations in the observed period. RESULTS: The majority of patients from both groups assessed their social functioning as improved, with significant differences found only in the area of romantic relations: more patients in the TAU group assessed their functioning as worsened. Nevertheless, a significantly higher number of patients in the PGP group were assessed by their therapists to have improved social functioning in all dimensions, except in the area of romantic relations, where there was no statistically significant difference between the groups. In comparison with the TAU group, twice as many patients in the PGP group turned to their psychiatrist for help and had four times fewer hospitalisations. CONCLUSION: Considering the limitations of this preliminary study, it can be concluded that the findings are promising, although further research is required to determine whether a psychodynamic approach to group psychotherapy truly leads to improved social functioning of patients with psychotic disorders.

Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: a preliminary study.

BACKGROUND: The "Sveti Ivan" psychiatric hospital in Zagreb, Croatia, offers an outpatient Early Intervention Program for psychotic patients. This program consists of psycho-educational workshops and group psychodynamic psychotherapy. Two important objectives of the program are improving and maintaining adequate cognitive functioning. AIMS: The current study examined changes in aspects of cognitive functioning in young patients with schizophrenia after 18 months and after 3 years of psychodynamic group psychotherapy. METHODS: The study included 28 patients who attended the Early Intervention Program for young patients with psychotic disorders; 10 patients had completed only the psycho-educational part of the program (comparative group), and 18 patients continued with group psychodynamic psychotherapy (experimental group). All patients completed the Revised Beta Examination. RESULTS: We observed a trend in the experimental group to achieve higher scores than the comparative group. The results for both groups tended to increase with time, and this increase was greater in the experimental group. CONCLUSIONS: While acknowledging the limitations of this preliminary study, we conclude that participating in psychodynamic group psychotherapy is related to increases in the cognitive functioning of patients with schizophrenia, and our results provide a sound basis for future research.

Dreams and fantasies in psychodynamic group psychotherapy of psychotic patients.

Work with dreams in the group analysis represents an important part of the analytical work, with insight into unconscious experiences of the individual dreamer, and his transferrential relations with the therapist, other members of the group, and with the group as a whole. The way dreams are addressed varies from one therapist to another, and in line with that, members of the group have varying frequency of dreams. In groups of psychotic patients dreams are generally rarely discussed and interpreted by the group, with analysis mainly resting on the manifested content. This paper describes a long-term group of psychotic patients which, after sharing the dreams of several members and daydreams of one female patient, their interpretation and reception in the group achieved better cohesion and improved communication and interaction, i.e. created a group matrix. Furthermore, through the content of dreams in the group, traumatic war experiences of several of the group members were opened and discussed, which brought with it recollections of the traumatic life situations of other group members. In expressing a daydream, a female member of the group revealed the background for her behaviour which was earlier interpreted as a negative symptom of the illness.

Platelet and serum calcium and magnesium concentration in suicidal and non-suicidal schizophrenic patients.

AIM: The main processes modulated by Ca and involved in the cause of schizophrenia are alteration in the dopamine and glutamate neurotransmitter system. Intracellular effects of Mg-ions are opposite to Ca-ions in competition at K-ion channels, in Na/K-ATP-ase activity, cAMP/cGMP concentration and Ca-ion currents in pre- and postsynaptic membranes. We conducted this research due to the incongruent results on Ca and Mg concentration that have been published until now and to determine platelet Mg concentration in suicidal and non-suicidal schizophrenic patients. METHODS: A group of schizophrenic patients consisted of 23 patients with attempted suicide (S-SCH) and 48 patients without suicidal behavior (K-SCH) diagnosed according to ICD-10 diagnosis (F20.0) with or without intentional self-harm (X60-X84). The control group (K) included 99 healthy voluntary blood donors. The Mg and Ca concentration in platelets and serum was determined by atomic absorption spectrophotometry on the AAnalyst 200. RESULTS: Using one-way anova test and manifold application of the Student-Newman-Keuls post-hoc test we established that there were higher concentrations of platelet Mg (µmol/109 platelets) (P=0.009, F=4.89) and lower concentrations of serum Ca (mmol/L) (P<0.001, F=19.18) in the S-SCH group of patients and higher concentrations of platelet Ca/Mg ratio in the K-SCH group of patients (P=0.006, F=5.37). CONCLUSION: A higher Ca/Mg ratio in the platelets of non-suicidal patients confirms indirect higher Ca concentration. Higher Mg concentration in the platelets of suicidal patients, considered a Ca antagonist, may represent a compensatory attempt to restrain Ca activity.

Platelet serotonin and magnesium concentrations in suicidal and non-suicidal depressed patients.

The pathophysiology and treatment of depression involves monoamine neurotransmitters and the magnesium (Mg)-modulated monoaminergic pathway. Serum and platelet Mg concentrations and platelet serotonin concentrations were measured in 79 depressed patients who had attempted suicide, and 101 patients without suicidal behaviour, according to the ICD-10 diagnoses F 33.2 and F32.2, with or without intentional self-harm (X60-X84). The control group consisted of 77 voluntary blood donors. The platelet serotonin concentration was determined using the competitive enzyme immunoassay test: Mg concentrations in platelets and serum were determined by atomic absorption spectrophotometry. The ANOVA test showed significantly lower serum Mg in the group of depressive patients who had attempted suicide (N = 257, F = 8.32, p<0.001), compared to depressive patients who had not, and the control group. Serum albumin was lower in the group of depressive patients who had attempted suicide and showed a significant, positive correlation with serum Mg concentrations. Platelet Mg concentrations were found to be higher in depressive patients who had not attempted suicide (N = 257, F = 3.90, p = 0.012) compared to the control group, with no difference compared to depressive patients who had attempted suicide. The Kruskal Wallis test (N = 257, H = 48.54, p<0.0001) showed the lowest concentration of platelet serotonin in the groups of depressed patients with and without suicidal behaviour, compared to the healthy control group. A positive correlation was found between platelet Mg and serotonin concentrations only in the healthy control group. In conclusion, differences were observed in serum and platelet Mg concentrations, which represent progress in the study of Mg status and its relation to serotonin.

Early intervention program for psychotic disorders at the psychiatric hospital "Sveti Ivan".

The Early intervention program for the first episodes of psychotic disorders (RIPEPP) at the Psychiatric Hospital "Sveti Ivan" in Zagreb encompasses patients hospitalized due to various psychoses (acute psychotic disorder, schizophrenia, schizoaffective and delusional disorder, bipolar affective disorder with psychotic symptoms) in the "critical period" of illness, i.e. within five years after the occurrence of the first symptoms. The RIPEPP Program consists of an in- and out-patient part, and includes psychotherapeutic and psychoeducative components as well as the administration of antipsychotics. The Psychotherapeutic part, conducted by psychotherapists - group analysts, comprises psychodynamic group psychotherapy for patients and for family members. The Psychoeducative part, led by cognitive-behavioral therapists, is carried out through educative interactive workshops for both patients and their family members. The paper describes the theoretical framework, as well as the professional, personnel, educative and organizational basis of the Program, the principles of evaluation and some experiences after five years of implementation.

Dementia and legal competency.

The legal competency or capability to exercise rights is level of judgment and decision-making ability needed to manage one's own affairs and to sign official documents. With some exceptions, the person entitles this right in age of majority. It is acquired without legal procedures, however the annulment of legal capacity requires a juristic process. This resolution may not be final and could be revoked thorough the procedure of reverting legal capacity - fully or partially. Given the increasing number of persons with dementia, they are often subjects of legal expertise concerning their legal capacity. On the other part, emphasis on the civil rights of mentally ill also demands their maximal protection. Therefore such distinctive issue is approached with particular attention. The approach in determination of legal competency is more focused on gradation of it's particular aspects instead of existing dual concept: legally capable - legally incapable. The main assumption represents how person with dementia is legally capable and should enjoy all the rights, privileges and obligations as other citizens do. The aspects of legal competency for which person with dementia is going to be deprived, due to protection of one's rights and interests, are determined in legal procedure and then passed over to the guardian decided by court. Partial annulment of legal competency is measure applied when there is even one existing aspect of preserved legal capability (pension disposition, salary or pension disposition, ability of concluding contract, making testament, concluding marriage, divorce, choosing whereabouts, independent living, right to vote, right to decide course of treatment ect.). This measure is most often in favour of the patient and rarely for protection of other persons and their interests. Physicians are expected to precisely describe early dementia symptoms which may influence assessment of specific aspects involved in legal capacity (memory loss, impaired task execution, language difficulties, loosing perception of time and space, changes in mood and behaviour, personality alterations, loss of interests and initiative). Towards more accurate determination of legal competency the psychometric tests are being used. The appliance of these tests must be guided with basic question during evaluation: "For what is or is not he/she capable?" In prediction of possible dementia development, the modern diagnostic procedures are used as help for potentially demented individuals in order to plan own affairs and by oneself determine future guardian. This ensures the maximal respect and protection of rights among persons with dementia in order to independently manage life one step ahead of progressive illness. Finally, it is to be distinguished medical concept of legal capacity which is universal and judicial concept which is restricted by rules of national legal system differing from country to country.

Thrombocyte serotonin and serum cholesterol concentration in suicidal and non-suicidal depressed patients.

INTRODUCTION: Numerous studies have confirmed the connection of reduced serum cholesterol and thrombocyte serotonin concentration with suicidal behavior in psychiatric patients. The purpose of such studies was to determine the link among cholesterol and serotonin concentration, comparing depressed patients with and without attempted suicide with phenotypically healthy control group. MATERIALS AND METHODS: The examinees' groups consisted of 55 depressed patients with suicide attempt and 77 depressed patients with no suicide attempt. In accordance to ICD-10, the above patients were separated in two subgroups; F32.2 and F33.2. Phenotypically healthy control group was presented by the group of healthy blood donors. The fasting serum cholesterol concentration was established using standard enzymatic method, while the thrombocyte serotonin concentration was determined by the enzymatic immune-chemical method (ELISA). RESULTS: The ANOVA test (N=228, F(ratio)=8.26, p<0.001) found significant difference of cholesterol concentration between groups, with lowest concentration in depressed patients with attempted suicide (SNK post hoc test, p<0.05). Upon gender stratification, the significance remained for the female patients (ANOVA, N=125, F(ratio)=6.06, p=0.003). The serum cholesterol was shown to be statistically lower in the group of depressed patients with attempted suicide, diagnoses F32.2 (p=0.031) and F33.2 (p=0.011), compared to the group of depressed patients without attempted suicides. The thrombocyte serotonin was found to be significantly different in all examined groups, with the lowest thrombocyte serotonin in the group of depressed patients with no suicide attempt (SNK post hoc test, p<0.05, N=187, F(ratio)=37.69, p<0.001). The same significance was found for the group of female (ANOVA, N=103, F(ratio)=11.81, p<0.001) and the group of male patients (ANOVA, N=84, F(ratio)=30.40, p<0.001). The thrombocyte serotonin was significantly lower in the group of depressed patients with no suicide attempt (F32.2), compared to the same diagnosis in the group of depressed patients with suicide attempt (MW-test, p=0.018). CONCLUSION: In the group of depressed patients with attempted suicide, statistically significant lower serum cholesterol values have been confirmed. In the group of depressed patients with no suicide attempt, statistically significant lower values of thrombocyte serotonin have been confirmed, presumably as the response to the psychopharmacological therapy.

Venlafaxine - quetiapine combination in the treatment of complicated clinical picture of enduring personality changes following PTSD in comorbidity with psychotic depression.

PTSD is a complex disorder, which frequently occurs in comorbidity with anxious disorder, personality disorder, addiction or substance abuse disorder, depressive disorder with or without psychotic symptoms and psychotic disorder. PTSD symptoms may result from deregulation of several different neurotransmitter systems. Pharmacotherapy of PTSD depends on clinical features and the presence of comorbid disorders. Pharmacotherapy of PTSD involves use of anxiolytics, adrenergic receptor antagonists, antidepressants, anticonvulsants and novel antipsychotics. Serotoninergic effect of antidepressants is not only effective in treating depression, but also appears to be helpful in PTSD treatment, particularly in reduction of intrusive symptoms, emotional reactivity, impulsiveness, aggression and suicidal ideation. Anypsychotics with serotoninergic-dopaminergic antagonism are being prescribed often in treatment of psychotic depression, while in PTSD treatment they are proved to be efficient in relieving intrusive symptoms and nightmares. Quetiapine as serotoninergic-dopaminergic antagonist is efficient in treatment of chronic insomnia as well as in reduction of aggressiveness. Considering PTSD refractoriness to therapy, high incidence of comorbidity and significant functional impairment, it is important to search for new psychopharmacological combinations in order to improve mental status of the patient. The paper presents 46 years old male patient with the diagnosis of Enduring personality changes following war PTSD (F62.0) in comorbidity with Recurrent depressive disorder with psychotic symptoms (F33.3), who was treated with combination of venlafaxine and quetiapine.

Cognitive impairment and general anaesthesia - Case report.

Degeneration of cholinergic receptors causes memory disorders and irreversible impairment in cognitive functions, whose advancement can lead to clinically recognizable Alzheimer's disease (AD). Very often, the first symptoms of AD are mood swings and hence depression should be excluded by differential diagnosis since it can also cause memory disorders and cognitive deficits. Due to the characteristic clinical picture of AD, its diagnosis should not be a problem, except at the very beginning of the disease. Many AD patients are never diagnosed and therefore are not adequately treated in clinical practice. Agents used for general anaesthesia reduce cholinergic transmission, which is manifested by loss of consciousness, pain, voluntary movements and memory. In patients with compromised memory and cognitive functionality, general anaesthesia can postoperatively have an adverse effect on the prognosis of degenerative cerebral disease. A patient is described whose preoperative impaired memory and cognitive functioning deteriorated after general anaesthesia and whose clinical picture reached the extent of AD.

Suicidality and side effects of antidepressants and antipsychotics.

Antidepressants and antipsychotics can cause side effects in various organs and organic systems, and some (and) in the central nervous system, which can also be clinically manifested by suicidal behavior as well. Tricyclic antidepressants particularly of imipramine and clomipramine can have pro-suicidal effect, which is believed to be the consequence of their own hypothetic asynchronous cognitive-psychomotor pharmacodynamic action. Antidepressants from the group of selective serotonin reuptake inhibitors can at the beginning of administration as monotherapy also have pro-suicidal effects in patients with hints of suicidality or suicidal behavior, by increasing the intensity of already present suicidal predictors, such as dysphoria, anxiety, impulsiveness, agitation etc. Antipsychotics can act stimulatingly upon predictors of suicidal behavior, that is, pro-suicidal in an indirect way through side effects they cause indirect pro-suicidal neurological and consecutive psychological impact, as it is called. It is particularly valid for classic antipsychotics causing primarily neurological, i.e. extrapyramidal side effects, along which consecutive psychological side effects can occur as well. However, new antipsychotics in comparison to classic ones, have less pronounced neurological, extrapyramidal symptoms and signs but more somatic-metabolic side effects, and thereby their action can be mostly manifested as indirect pro-suicidal neurological and somatic-metabolic as well as consecutive psychological activity.

The role of CYP2D6 and TaqI A polymorphisms in malignant neuroleptic syndrome: two case reports with three episodes.

Malignant neuroleptic syndrome (MNS) is a serious and potentially fatal side-effect of neuroleptic treatment. Beside antipsychotic drugs, other psychotropic drugs such as antidepressants and lithium carbonate can cause this life threatening side-effect. Underlying mechanism of this side-effect is still unknown and debated. So far some risk factors have been identified, with clinical observations and recent pharmacogenetic research suggesting (with inconsistent findings) correlation between genetic mechanisms and predisposition to MNS. Polymorphisms of CYP2D6 enzyme through which most psychotropic drugs are metabolized and TaqIA DRD2 which is target for antipsychotic drugs could be the link between pharmacogenetic factors and potential for development of MNS. In this paper we present two case reports with clinical presentation of three consecutive MNS. One patient developed MNS while he was taking combination of drugs: first time haloperidol, promazine and fluphenazine, second time fluphenazine and perazine and third time clozapine, promazine and valproic acid consecutively. The other patient developed MNS while taking following combination of drugs: first time haloperidol and lithium carbonate, second time risperidone and third time clozapine consecutively. Pharmacogenetic analysis for CYP2D6 and TaqI A DRD2 polymorphisms for both patients was done. Genotypisation of CYP2D6*1*3*4*5*6 in both patients showed no evidence of poor metabolizer phenotype. On the other hand, first patient was heterozygous for CYP2D6*4 (genotype *1/*4). CYP2D6 polymorphisms could have clinical significance because may lead to toxicity and unwanted side-effects in standard usual antipsychotic dose ranges. Analysis Taql A DRD2 polymorphism for first patient showed that he is heterozygous for A1 allele (genotype A1A2) which is commonly associated with predisposition to MNS. According to our literature three consecutive MNS are rarely described, and incidence of MNS generally is too low to perform clinical research. Many patophysiological mechanisms may probably underlie this complex and potentially fatal syndrome, still unknown etiology. But, genetic mechanisms could be significant. Further pharmacogenetic research, findings and analysis in patients who develop single or repeated MNS are strongly recommended. In long term, pharmacogenetic analysis, implemented in daily clinical practice, could help in prevention of this extremely serious side-effect.

Infection or idiosyncratic reaction to antiepileptic drugs?

Idiosyncratic reactions are serious, unpredicted adverse effects of antiepileptic drugs which are in use in psychiatry as mood stabilizers. Severe idiosyncratic reactions can manifest as systemic symptoms or Dress syndrome clinically manifested with increased body temperature, peripheral lymphadenopathy and potential one or multiple organ failure. We present a 36 years old patient, who was hospitalized for the first time in our hospital after he attempted suicide by hanging. Patient was diagnosed as Bipolar affective disorder, current episode depressive with psychotic features and high suicidal risk. At the time of admission he was taking olanzapine and venlafaxine. Psychopharmacs were cross titrated to clozapine, valproic acid and lamotrigine. Two weeks later, patient's mood was stabilized but his somatic status worsened dramatically. He was forwarded to Clinic for Infective Diseases where he was diagnosed with severe sepsis. Dress syndrome, although initially suspected was not verified, but has to be taken into consideration in each patient prescribed with antiepileptic drugs.

Comparative study on gene tags of the neurotransmission system in schizophrenic and suicidal subjects.

Schizophrenia and suicidal behaviour are sever and complex mental disorders, largely determined by factors of inheritance. Both disorders present pathological changes in the catecholamine neurotransmitter system. The study was conducted on three groups; a group of subjects suffering from schizophrenia, a second compounded by individuals who attempted suicide and a third group of phenotypically healthy examinees. The blood samples of schizophrenic patients as of those who attempted suicide were obtained at the Psychiatric Hospital "Sveti Ivan" in Zagreb in the year 2004. Tests were conducted on the statistic relation between a total of 18 SNPs within three candidate-genes of the dopamine and adrenergic system (DRD4, SLC6A3 and ADRA2B) and the manifestation of schzophrenia and suicidal behaviour. Cases were genotyped by use of SNPlex system. Statistically significant differences were determined in the allelic frequency between the mentioned groups. Findings show a significant connection between 4 SNPs (ADRA2B rs749457, SLC6A3 rs464094, DRD4 rs11246226 and rs4331145) and schizophrenia, and 2 SNPs with suicidal attempt (ADRA2B rs1018351 i SLC6A3 rs403636). In addition, this is the first study that highlights the potential role/effect of polymorphisms in ADRA2B on the manifestation of schizophrenia, as on suicidal behaviour.

Serotonin and cortisol as suicidogenic factors in patients with PTSD.

Post-traumatic stress disorder (PTSD) frequently occurs in commorbidity with different mental disorders, including suicidal behaviour. Group of biological factors, including serotonergic system, HPA axis and some genetic factors, are being studied as potential markers, able to differentiate suicidal and non-suicidal behaviour across the group of PTSD patients. This study is examining statistical relation between platelet serotonine concentration and serum cortisole concentration, within the group of PTSD patients with and without attempted suicide, treated at "Sveti Ivan" Psychiatric Hospital in Zagreb. The hypothesis of this study is that periferal biochemical markers are different across the groups of PTSD patients with and without attempted suicide and the group of healthy controls. Our results have shown significantly lower platelet serotonine concentration in PTSD patients with and without suicide behaviour, compared to healthy controls. There are no statistically significant differences of the serum cortisole concentration across observed groups. Our results correspond with those reported by other authors in this area of research, suggesting that platelet serotonine level might be used as potential periferal marker to detect risk of suicidal behaviour in PTSD patients.