Differences in Resilience, Self-Stigma and Mental Health Recovery between Patients with Schizophrenia and Depression.

INTRODUCTION: There is growing evidence that resilience is a key factor for prevention of mental disorder. Low resilience levels were found in individuals at clinical high risk to psychosis and schizophrenia. Higher level of resilience was associated with better functioning, less severe negative, anxiety and depressive symptoms. Low level of self stigma is associated with recovery from schizophrenia. Aim of this paper was to determine whether resilience and self-stigma are significant predictors of mental health recovery in patients diagnosed with schizophrenia and depression treated in a rehabilitation-oriented program. SUBJECTS AND METHODS: 51 patients diagnosed with psychoses and 53 patients with depression treated in day hospital participated in this study. Internalized Stigma of Mental Illness Scale (ISMI), The Boston University Empowerment Scale (BUES), Perceived Devaluation and Discrimination (PDD) Scale, Mental Health Recovery Measure (MHRM) and Resilience questionnaire were used. RESULTS: Self-stigma positively correlates with PDD (r=0.44; p=0.000), and negatively with BUES (r=-0.78; p=0.000), resilience (r=-0.51; p=0.000) and with recovery (r=-0.59; p=0.000) in two groups. In addition, a higher PDD score indicates poorer levels of empowerment (r=-0.42; p=0.000), resilience (r=-0.35; p=0.000) and recovery (r=-0.44; p=0.000). Mental health empowerment, resilience and recovery all correlate significantly and positively with each other. Cross-group comparison results show the best results for patients with schizophrenia. Sociodemographic factors do not affect resilience, self-stigma nor recovery. CONCLUSION: Self-stigma and resilience are connected with moderate correlation. Research supports the need for interventions that prevent self-stigma and increase resilience in the treatment of schizophrenia patients.

The impact of a rehabilitation day centre program for persons suffering from schizophrenia on quality of life, social functioning and self-esteem.

BACKGROUND: Presently few studies demonstrate improved outcomes in patients with schizophrenia treated in day rehabilitation centres. One reason is the absence of an evidence based protocol for rehabilitation in such centres. Hence further research is required to assess whether such a protocol will improve psychosocial outcomes. AIMS: We performed a controlled evaluation study of a protocol based rehabilitation day program (RDC) for persons suffering from schizophrenia. METHODS: Patients from the experimental group (N=50) were treated within the RDC for a 6 month period. The control group were patients on the waiting list for the RDC. Quality of life (MANSA), social functioning (OSA) and self-esteem (Rosenberg) were measured before and after the intervention. RESULTS: Statistically significant improvement was shown in social functioning measured by OSA (F(1,96)=33.7; p<0.001), quality of life measured by MANSA (F(1,96)=69.3; p<0.001) and self esteem measured by Rosenberg scale (F(1,96)=84.5; p<0.001) for patients treated in the RDC compared with the control group, conversely, the control group outcomes deteriorated. CONCLUSION: An evidence based protocol for rehabilitation within the RDC lead to improved social outcomes and recovery for persons suffering from schizophrenia.

Stigma in clinical practice.

Much more is known about attitudes toward mental illness and social stigma, the viscious cycle of its consequences and how to fight the social stigma in public, but much less is known about how to combat the stigma and self stigma in clinical practice. Stigma theories have not been enough to understand the feelings and experience of people with mental illness. Conceptual framework that understands stigma as consisting of difficulties of knowledge (ignorance or misinformation), problems of attitudes (prejudice), and problems of behaviour (discrimination) have not o been enough to understand stigma dynamics in the patient therapist interaction. Understanding the psychodynamic aspects of internalized stereotype of mental illness in the patient- therapist relationship may improve our competency to deal with stigma and self stigma in clinical practice.

[Excessive daytime sleepiness--as possible suicidal equivalent in people with depressive disorder]. / Prekomjerna dnevna pospanost kao moguci suicidalni ekvivalent u osobe oboljele od depresivnog poremecaja.

This paper presents the case of a patient suffering from atypical depression, with excessive daytime sleepiness, which was a suicidal equivalent. Patients who suffer from depression and sleep disorders can have an increased risk of suicidality, and to them should pay increased attention. Field of suicide as a means of resolving conflicts and unconscious mental escape from the reality of the obstacles, including sleep and daytime sleepiness, which may represent a form of "temporary suicide". The authors recommend that hypersomnia, daytime sleepiness in depressed patients and other sleep disorders should be treated as a potential risk factor for suicidal behavior.

[Diagnostic and therapeutic algorithm for the treatment of premenstrual dysphoric disorder]. / Dijagnosticke i terapijske smjernice za lijecenje predmenstruacijskog disforicnog poremecaja.

Many women experience psychological and physical symptoms associated with menstrual cycle. In 3% to 5% of women that meet the criteria for premenstrual dysphoric disorder, the symptoms are severe and impair their social and occupational functioning. Although the etiology of premenstrual dysphoric disorder is unknown, the symptoms of dysphoria, including depression and anxiety, have been associated with serotonergic dysregulation. Selective serotonin reuptake inhibitors, taken only during the symptomatic luteal phase, are considered as first-line therapy for premenstrual dysphoric disorder.

Psychodynamic understanding and psychotherapeutic approach to psychoses.

The historical development of the psychodynamic approach to psychotherapy is described. The origins of ISPS are described, and ISPS Croatia and Slovenia are introduced.

Trauma, shame and psychotic depression experienced by ex-POWs after release.

Modern societies are growing ever more sensitive to the various sources and many kinds of psychic traumas, resulting even in psychotic reactions or states of functioning. Especially the war captivity situation represents the prolonged basis for chronic severe psychic stress and traumatisation, that may become deleterious even for the core self of the person. Severely psychotraumatized war veterans, or ex-POWs in the aftermath of the war captivity situation, survivors of extreme forms of violence and humiliation, are very reluctant to recall traumas. This avoidant behaviour is many times one of the most prominent symptoms that should be recognised and confronted in order to start the retraumatising process of healing the previously unthinkable traumas. The authors believe that shameful feelings are at the very basis of the psychotraumatised persons' withdrawal, depression, suicidal attempts, and even psychotic answers. The main feature of the first phase of any therapeutic work with these patients is the mourning process that should be gradually unfolded. The clinical examples will illustrate therapeutic work with these patients. The authors will expose some basic psychodynamic approaches and concepts regarding shame. This difficult feeling will be put in relationship with the psychotic answers. In that frame of reference the concept of 'near psychosis' will be described.

Gender and schizophrenia.

In accordance with the predominant view on the neurobiology of schizophrenia, most of the research on the differences in the illness between men and women has been studied on the basis of sex difference as a biological category rather than on the basis of gender as a psychosocial category. There are gender- identity difficulties observed in schizophrenia. Problems associated with gender can be a major source of instability and vulnerability during the development of the first and later psychotic episodes. There is a need for future research to view sex difference through gender perspectives. Findings from a gender study may have utility for the development of differential treatment interventions for men and women and may improve the outcome of the illness in general. The study of the complex role of gender in illness processes is an important research direction that would enhance our understanding of the heterogeneity in the manifestation and subjective experience of schizophrenia.

[Have we forgotten neurological diseases with psychological symptoms? Case study: Huntington's chorea]. / Da li smo zaboravili na neuroloske bolesti s psihickim simptomima? Prikaz slucaja: Huntingtonova horeja.

Huntington's cohrea is neurodegenerative disorder with high incidence of different psychiatric symptomathology including mood symptoms, dementia and psychotic symptoms. Very often psychic symptoms come before the typical motor symptoms. This paper demonstrates difficulties in diagnostic process for Huntington's chorea in the case when psychiatric symptoms come before the motor symptoms. We should take in account neurodegenerative disorder in the case of psychiatric disorder with atypical clinical pictures without adequate response on standard treatment.