Introduction: Depressive symptoms are occured in 31% patients with diabetes mellitus. In patients with diabetes mellitus is risk for development of depression two times higher in compare with general population. We know some risk factors – demographic (female gender, younger age, lower education, poorness), clinical (relevance of diabetes, disorder length, complications of diabetes, increased leveles of glycosyled haemoglobin HbA1c) behavioural (smoking, obesity), which more or less related to occur depression in patients with diabetes. Among the endocrine and neurotransmitter changes include decreased concentrations of catecholamines, mainly 5-HT, stimulation the production of glucocorticoides, growth factor and glucagon, which act counter to the hypoglycaemic action of insulin. Increased cortisol levels are observed equally in patients with diabetes and depression, like impaired glucose tolerance and the development of insuline resistance. Common occurrence of these two disorders is not a random phenomenon, which gives account of their possible relationship. The depression arises as a direct result of neurochemical changes associated with diabetes or depression is result of psychosocial factors related to disease/treatment or on other hand if depression is a independent risk factor for diabetes. AIM: The main objective of this work was to assess the safety of antidepressant treatment in terms of the impact on selected glucose and lipid metabolic parameters in the group of SSRI´s and SNRI´s preparations in patients with major depressive disorder in natural conditions. A side goal was to assess the effectiveness of treatment for depression and compare the two groups to each other antidepressants. Methods: A follow-up included a total of 74 patients with a diagnosis of a depressive phase or recurrent major depressive disorder who were the clinical discretion of the physician divided into two subgroups. One subgroup was treated with SNRI´s (studied group), the second group was treated with SSRI´s (control group) in a flexible dosing. Every patient was performed before treatment, at the third and sixth month of treatment, laboratory tests to evaluate the glycemic and lipid parameters and every patient also underwent assessment of psychopathology using the MADRS scales, Zung questionnaire depression and Beck anxiety questionnaire. Results: In the group studied SNRI´s occurred during and after treatment to no significant increase in blood glucose (oGTT) of 5.16 / 7.29 to 5.26 / 7.51 (ns), HbA1c decreased from 5.54 to 5.29 ( ns). LDL cholesterol increased from 3.15 to 3.18 (ns), HDL cholesterol increased from 1.31 to 1.38 (ns). Differences in levels of total cholesterol in the three follow-up were not significant (5.28 vs. 5.23, ns), but the trend over a longer follow-up assumes significance because post hoc tests showed a significant difference in the decrease of total cholesterol between the first and second follow-up. Triglycerides increased from 1.81 to 1.92 (n. s.). BMI in the group of patients with SNRI preparations are no significantly changed from 27.03 to 27.35 (ns). MADRS total score significantly decreased from 36.36 to 11.56 (p <0.001) in the SDS index Zung questionnaire depression significantly decreased from 66.95 to 51.26 and Beck questionnaire scores in anxiety significantly decreased from 23.72 to 15 , 92 In the control SSRI group differences in blood glucose levels (oGTT) during three follow-up were not significant (4.7 / 5.1 vs 6.33 / 6.33, ns), but the trend over a longer follow-up assumes significance because post hoc tests showed significant difference in the increase of blood glucose (oGTT) between the second and third follow-up. HbA1c decreased from 5.22 to 5.18 (n. s.). We have seen a statistically significant increase in LDL cholesterol (p = 3.52 *) with longer follow trends in assuming even greater significance since the post hoc tests showed a significant difference in the increase in LDL choles
Introduction: Bipolar disorder (BD) is chronic psychiatric disorder by mood swings, symptoms of BD are serious and life-threating. Suicide risk in patients with BD is 25-50%, more frequent during depressive episode (Compton,2000) but with adequate treatment suicide risk can be presented in nearby 50% of patients only (Goodwin, Jamison,2006). Despite these facts data about the changes of treatment habits over the longer period of time under naturalistic condition are lacking. The aim of study: To assess presence of suicidal thoughts and attempts in inpatients with BD and follow-up changes of treatment with lithium over the period of time. Patients and methods: It was retrospective survey of in-patient's files hospitalized at the 1st Dept. of Psychiatry, UPJS, Kosice (1997-2007) with typical limitations for retrospective case survey. All patients had diagnosis of BD (DSM-IV), n=125 (67% of women and 33% of men). We discovered changes in suicidal behaviour with/without treatment of lithium. Results: The first episode was depressive in 62% of patients, average number of episodes: 8,2. There was trend of decrease in use of lithium over the time (68% vs 84% in men, 29% vs 60% in women). The suicidal thoughts were more frequent during depressive episode (in 50% of women and 18% of men). Suicidal thoughts and attempts were 3 times more frequent in women vs men with BD. Suicidal attempts were 4 times more frequent in women with treatment with lithium vs without lithium.
Social participation is an important aspect associated with health-related outcomes in chronic diseases. However, little is known about the factors that may affect participation in patients with rheumatoid arthritis (RA). We aimed to examine whether pain, fatigue, anxiety, depression, and illness perception are associated with social participation in patients with RA when controlled for clinical and sociodemographic variables. We also analysed the mediating role of illness perception in the association between physical and psychological variables on social participation.
This report maps autism and special education needs (SEN) policies, alongside teacher responsibilities in the education of children with SEN in Austria, Hungary, Czech Republic, and Slovakia. A policy path analysis using a scoping review as an underlying methodological framework was performed. The end of communism and accession to the European Union were critical for the countries under study. They passed crucial policies after international policies and adopted a three-stream approach towards providing education: (1) special schools; (2) special classes in mainstream schools; or (3) mainstream classes. Special schools remain for children that cannot participate in mainstream schools. Teachers are given high levels of responsibility. Changes in international guidance greatly impacted Austria, Hungary, Slovakia and the Czech Republic. The education systems aim for inclusion, though segregation remains for children that cannot thrive in mainstream schools. Teachers are pivotal in the education of children with SEN, more so than with typical children.
Background Emerging issues in the management of major depressive disorder (MDD) comprise a nonadherence to treatment and treatment failures, depressive recurrence and relapses, misidentification of incoming exacerbated phases and consequently, a chronification of depression. While antidepressant drugs constitute the standard of care for MDD, effective psychosocial interventions are needed to reduce rehospitalizations and other adverse events. The present study primarily investigated the effects and impact of implementing a structured psychoeducational intervention on the clinical course of MDD. Methods A non-randomized comparative, pragmatic, pilot, single-center study of adults with nonpsychotic moderate or severe episode of MDD recently discharged from a psychiatric hospitalization. The consecutive subjects were allocated either to the intervention group ( N =49) or to the attention control group ( N =47), based on their preference. The psychoeducational intervention was based on a modified Munoz’s Depression Prevention Course. Subjects were followed up prospectively for two years. Results The absolute changes in Beck anxiety inventory scale, Zung’s depression questionnaire, and Montgomery and Äsberg depression rating scale (MADRS) total scores at 6-month follow-up were comparable between the two groups. There were lower rates of the rehospitalization within one year (2.1% vs. 16.7%; P <0.001) and less rehospitalizations after one year (6.3% vs. 25%; P <0.001), lower rates of the ongoing sickness absence (11.5% vs. 29.2%; P <0.001), less persons with disability due to MDD at 1-year follow-up (1% vs. 11.5%; P =0.002), and less nonadherent subjects who self-discontinued treatment (6.3% vs. 28.1%; P <0.001) among participants in the intervention group compared to the control group. The disability due to MDD at 1-year follow-up was predicted by the absence of the psychoeducational intervention ( P =0.002) and by the MADRS total score at 6-month follow-up (OR 1.10; 95% CI 1.003–1.195; P =0.044). Qualitative data indicated the intervention was desired and appreciated by the participants, as well as being practical to implement in Slovakian clinical settings. Conclusion The results suggest the psychoeducational intervention based on a modified Munoz’s Depression Prevention Course has beneficial effects in adults with MDD recently discharged from a psychiatric hospitalization. The findings implicate the psychoeducational intervention may offer a new approach to the prevention of depressive relapses.
The article presents a case report of a family whose members became ill with induced delusional disorder (folie a famille). The biopsychosocial basis of induced psychosis and psychopathological aspects of patient identification are discussed. The authors hypothesized that paranoid psychosis in the described case developed depending on the interaction between the inducer with the primary endogenous paranoid psychopathological symptomatology and the two induced emotionally bound individuals. One of the induced individuals simultaneously suffered from personality disorder and the other from primary organic brain dysfunction. This is a case of induced psychosis, a type of folie a imposee that developed within the family. The inducer was a daughter; her mother and grandmother were secondarily induced by the disease, while the grandmother’s role was the role of a catalyst.
Background: Schizoaffective Disorder (SAD), similarly to schizophrenia, is a potentially chronic mental disorder that negatively affects the functioning of a patient. Various issues in everyday clinical practice often arise from its diagnostic and therapeutic uncertainty. To date, there is a lack of a well-defined therapeutic algorithm used to treat the simultaneously manifesting schizophrenic and affective components. The aim of this study was to compare the therapeutic approaches in schizophrenia and schizoaffective disorders to identify the need of different treatment strategy for these diseases. Methods: In a retrospective study, we evaluated the therapeutic algorithms used in all patients with SAD (n = 99) hospitalized at the Department of Psychiatry, Comenius University in Bratislava, Faculty of Medicine and University Hospital Bratislava throughout the year 2010 and compared them with the therapeutic procedures used in all schizophrenia patients hospitalized in the same year (n = 120). Results: We found similarities between the groups of patients with schizophrenia and SAD in the number, type and length of hospitalizations and general patient management. Differences were identified in terms of the spectrum of used pharmacotherapy. For the treatment of both mental disorders, atypical antipsychotics were used the most. In the treatment of schizophrenia, we found the most frequent use of combined antipsychotic therapy, meaning oral and long-acting injectable forms. Patients with SAD mostly received antipsychotic monotherapy, but its complex effects were supplemented with other psychotropic drugs, mostly mood-stabilizers and anxiolytics. Conclusion: The results of our study show similarities between schizophrenia and SAD in terms of health care utilization, despite the fact that SAD is generally considered to be a “milder” disorder. On the other hand, this study indicates differences in the spectrum of pharmacotherapy used.
