No abstract

When designing clinical trial or considering decision to take part in particular clinical trial as investigators, even before submission to responsible Central Ethic Committee, we always make certain private assessment about ethical justification of this clinical trial. When making assessment if any clinical trial is ethically justifiable, there should make no difference in which country this clinical trial will be executed. Physicians coming from developing countries must ensure that patient population of developing countries is not misused in any ethically questionable clinical trial. There must be careful assessment of clinical protocols by various independent local advisory committees (e.g. hospital review boards, hospital drug committees, hospital administration and whatever is applicable) to exclude the possibility that only one person or one group of people has concentrated power to make decisions for entire country. Many times physicians/clinical researchers from developing countries are faced with the criticisms that they are not of the same quality as physicians from developed countries and that they can be easily bribed by sponsors, which are based on the prejudice that any clinical trial can be executed in developing countries, no matter of quality or risks for patients. Physicians coming from developing countries must ensure that patient population of developing countries is not misused in any ethically questionable clinical trial.

SUMMARY -Alcohol addiction is a heterogeneous psychiatric disorder according to both phenotype and etiology. Difference in phenotype characteristics manifests in the manner the addiction arises, history of the alcoholic and history of drinking, comorbid disorders, and the phenomenon of abstinence difficulties. Concerning the etiology of alcoholism, the disease itself is considered to be a consequence of an interactive influence of the environment and genetic factors. Numerous researches conducted in the last decades discovered many aspects of the biochemical, cell and molecular bases of alcohol addiction, leading to a conclusion that alcoholism is, like many other addictions, a brain disease. By recognizing alcoholism as a disease which basically implies changes of the neurobiological mechanisms, as well as a clear genetic basis, it was supposed that the disease, having its basis solely in the symptomatology, is essentially heterogeneous. By trying to solve the problem of a clinically heterogeneous nature of the disease during the last fifty years, various sub-classifications of such patients have been suggested. According to Cloninger, subtypes of alcoholism differ also according to changes in the brain neurotransmission systems, i.e. it is supposed that patients suffering from alcoholism type 1 have a more pronounced dopaminergic transmission deficit, while dopaminergic transmission is not disturbed significantly in patients diagnosed with alcoholism type 2, who, however, have a significant lack of serotonergic transmission. In such a way, Cloninger actually presented the basis of the so-called neurobiological alcoholism model. Since he has connected differences in neurotransmission with differences in personality characteristics, this model is also known as the psychobiological model of alcoholism. The characteristic of alcoholism type 1 is avoiding damage (Harm Avoidance, HA) decreased dopamine transmission and increased serotonin transmission, while the significant characteristic of alcoholism type 2 is seeking for excitement (Novelty Seeking, NS), unchanged dopamine transmission and decreased serotonin transmission. These neurochemical differences among alcoholism subtypes represent the basis for a different therapy approach. Intake of alcohol changes different gene expression in the human brain. The inheritance model of alcoholism is not fully explained, however, it is considered that the disease is connected to a larger gene number included in neurotransmission, cell mechanisms and general metabolic function, with a simultaneous influence of the environment. The contribution of genetic factors is stronger in certain types of alcoholism and thus we have been confronted in the last years of alcoholism research with studies researching the connections of some alcoholism subtypes with the polymorphism phenomenon in the genes coding the synaptic proteins included in the alcoholism etiology. The primary role of monoamine oxidase (MAO) in the brain is catalysis of deamination of the oxidative neurotransmitter a...

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.

<b><i>Introduction:</i></b> Vitamin D is involved in brain development and functioning, as well as in regulation of neurotrophic factors. Changes in the expression of those factors are possibly responsible for morphologic abnormalities and symptoms in patients suffering from schizophrenia. <b><i>Objective:</i></b> The main goal of this research was to investigate the interrelationship between vitamin D, nerve growth factors (NGF, brain-derived neurotrophic factor [BDNF], and neuregulin-1 [NRG1]), and schizophrenia symptom domains. <b><i>Methods:</i></b> This research included 97 inpatients diagnosed with schizophrenia. Schizophrenia symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Blood samples were taken in order to analyze concentrations of vitamin D, BDNF, NRG1, and NGF growth factors. The obtained results were used in a multiple regression analysis. <b><i>Results:</i></b> The vitamin D concentration positively affected the concentration of NRG1 (<i>F</i> = 8.583, <i>p</i> = 0.005) but not the concentration of other investigated growth factors (BDNF and NGF). The clinical characteristics and symptom domains of schizophrenia seemed to be unaffected by the concentrations of vitamin D, BDNF, and NGF, while the NRG1 concentration significantly affected positive symptom domains of schizophrenia (<i>F</i> = 4.927, <i>p</i> = 0.030). <b><i>Conclusion:</i></b> The vitamin D concentration positively affected NRG1 levels but not schizophrenia symptomatology as measured by PANSS. The as­sociation between the two could be intermediated via NRG1.

In 1937, Ugo Cerletti and Lucio Bini performed electroconvulsive treatment (ECT) in Rome for the first time. That was the time when different types of 'shock therapy' were performed; beside ECT, insulin therapies, cardiazol shock therapy, etc. were also performed. In 1938, Cerletti and Bini reported the results of ECT. Since then, this method has spread rapidly to a large number of countries. As early as 1940, just two years after the results of the ECT had been published, it was also introduced in Croatia, at Sestre milosrdnice Hospital, for the first time in our hospital and in the then state of Yugoslavia. Since 1960, again the first in Croatia and the state, we performed ECT in general anesthesia and continued it down to the present, with a single time brake.

Me ta bo ličke nus po ja ve no vi jih an tip si ho ti kaMe ta bo lic si de-eff ec ts of no vel an tip sycho tic dru gs Ana Kovak-Mufi ć 1 , Da li bor Karlović 1 , Mar ko Mar ti nac 2 , Dar ko Ma rčin ko 3 , Ka ti ca Letinić 1 , Bran ka Vid rih 1 1 Kli ni ka za psi hi jat ri ju, Kli nička bol ni ca "Ses tre mi los rdni ce", Zag reb, Hr vat ska 1 De par tme nt of Psychiat ry, Ses tre milos r dni ce Uni ver si ty Hos pi tal, Zag reb, Croa tia 2 Cen tar za pre ven ci ju i iz van van bol ničko li ječenje ovis nos ti, Mos tar 2 Cen ter for Prevention and Treatment of Addictions, Mos tar, Bosnia & Herzegovina 3 Kli ni ka za psi hi jat ri ju, Kli nički bol nički cen tar Zag reb, Zag reb, Hr vat ska 3 De par tme nt of Psychiat ry, KBC Zag reb, Zag reb, Croa tia SažetakPr vi opi sa ni slučaje vi me ta bo ličkih nus po ja va an tip si ho ti ka pot ječu još od vre me na ka da se ti li je ko vi uvo de u kli ničku upotre bu, tj. sre di nom pe de se tih go di na prošlog sto ljeća. Po ka za lo se, međutim, da se me ta bo ličke nus po ja ve ne jav lja ju sa mo kod prim je ne kon ven cio nal nih an tip si ho ti ka, po put klor proma zi na. Da nas smo suočeni sa sličnim prob le mi ma kod prim je ne no vi jih, ta kozvanih ati pičnih an tip si ho ti ka. Uvođenje ati pičnih an tip si ho ti ka u te ra pi ju bitno je unap ri je di lo li ječenje bo les ni ka sa shi zof re ni jom i os ta lim psi ho tičnim po re mećaji ma. Glav na pred no st ovih li je ko va u od no su na kon ven cio nal ne an tip si ho ti ke je ma nja učes talost ek stra pi ra mid nih nus po ja va, kao i hi per prolak ti ne mi je, te sveu kup no bo lja pod nošlji vo st. Ipak, ne ki od ati pičnih an tip siho ti ka po ve zu ju se s po ras tom tje les ne težine, po ja vom šećer ne bo les ti i poras tom vri jed nos ti ko les te ro la i trig li ce ri da. Ovaj se pregled ba vi raz li ka ma u dje lo va nju po je di nih ati pičnih an tip si ho ti ka na ho meos ta zu glu ko ze i in zu li na te me ta bo li zam li pi da, kao i pi ta njem na ko ji način ra cio nal no prim je nji va ti an tip si ho ti ke kod ko jih se jav lja ju me tabo ličke nus po ja ve. Od nos no, da ju se prepo ru ke, po pr vi put u Hr vat skoj, za sva kod nev ni kli nički rad o to me ka ko nad zi ra ti me ta bo lički sta tus bo les ni ka li ječenih no vi jim an tip si ho ti ci ma. Ključne ri ječi: me ta bo lički sin drom, nus po ja ve, an tip si ho ti ci, me ta bo li zam li pi da, me ta bo li zam glu ko ze

In March 2020, three months after the first cases surfaced in the Chinese city of Wuhan, WHO declared a global pandemic of the novel coronavirus, which by than had already spread through a great number of countries all over the world. In order to protect the health of healthcare workers and patients, activities and measures of disease prevention have been taken; in such circumstances, psychiatry found itself faced with various challenges, one of them being the preservation of the continuity of electroconvulsive therapy (ECT) in patients with severe or refractory psychiatric disorders. Such patients are a priority and demand immediate treatment in hospital settings adapted to epidemiological circumstances. Having studied the instructions and recommendations of the competent authorities, as well as reviewing available literature, this paper presents the most important measures for the smooth performance of ECT in conditions associated with the COVID-19 disease.