Browsing by Author "Jašović-Gašić, Miroslava (55945351100)"

A case is reported of a 36-year-old male, found dead in his locked room, lying on a bed, dressed in his mother's clothes, with a plastic bag over his head, hands tied and with a barrel wooden cork in his rectum. Two pornographic magazines were found on a chair near the bed, so that the deceased could see them well. Asphyxia was controlled with a complex apparatus which consisted of two elastic luggage rack straps, the first surrounding his waist, perineum, and buttocks, and the second the back of his body, and neck. According to the psychological autopsy based on a structured interview (SCID-I, SCID-II) with his father, the deceased was single, unemployed and with a part college education. He had grown up in a poor family with a reserved father and dominant mother, and was indicative of fulfilling DSM-IV diagnostic criteria for alcohol dependence, paraphilia involving hypoxyphilia with transvestic fetishism and anal masturbation and a borderline personality disorder. There was no evidence of previous psychiatric treatment. The Circumstances subscale of Beck's Suicidal Intent Scale (SIS-CS) pointed at the lack of final acts (thoughts or plans) in anticipation of death, and absence of a suicide note or overt communication of suicidal intent before death. Integration of the crime scene data with those of the forensic medicine and psychological autopsy enabled identification of the event as an accidental death, caused by neck strangulation, suffocation by a plastic bag, and vagal stimulation due to a foreign body in the rectum. © Medicinska naklada.

The aim of the study was to analyse the prevalence of polypharmacy with antipsychotic drugs and analyse types of coprescribing episodes at the University Psychiatric Hospital in Serbia. A sample of 120 patients (198 hospitalisations) was analysed. The prevalence of polypharmacy was calculated as the proportion of patients receiving two or more antipsychotic drugs concomitantly for at least 28 days. Total daily antipsychotic drug load was calculated as the number of defined daily doses (DDDs) of drugs per patient per day. It was compared between patients receiving monotherapy and patients receiving polypharmacy. Statistics was performed using standard statistical methods. Monotherapy was prescribed during 32.3% hospitalisations (n = 64), while polypharmacy was noted in 67.7% (n = 134). Polypharmacy with two drugs was observed during 126 (63.6%) hospitalisations and three antipsychotics were prescribed concomitantly during 8 (4.1%) hospitalisations. Patients' characteristics were not significantly different between patients who received only monotherapy and patients receiving polypharmacy. Patients on monotherapy had significantly more prior hospitalisations than patients from the other group (t = 3.94, df= 119, p < 0.001). The prevalence of polypharmacy patient episodes (67.7%) is approximately 100% higher than the prevalence observed in developed European countries. The explanation of such prescribing habit of Serbian psychiatrists requires further investigation. The only distinguishing factor between patients receiving monotherapy and patients receiving polypharmacy is the number of prior hospitalisations. © 2007 John Wiley & Sons, Ltd.

Objective: To prospectively evaluate depressive symptoms and risk factors for depression in patients with chronic hepatitis C (CHC) treated with pegylated interferon alpha therapy combined with oral ribavirin (PEG-IFN-α+RBV) and to analyze self-rating scale for depression in comparison to observer-based scale in the given population. Subjects and methods: The Hamilton Depression Rating Scale and Zung Self Rating Depression Scale were used to screen for depressive symptoms in 74 subjects with CHC before PEG- IFN-α (mean dose 152.6±25.6 mcg), and in the follow-up visits (4, 12 and 24 week). Results: Incidence of depressive symptoms in patients (mean age 39.9±13.4 years; equal sex distribution p=0.225) treated by PEG- IFN-α was the highest on 12th week of the treatment, when more than a 20% of our sample had moderate/severe symptoms of depression, and about 30% had minor depressive symptoms. For the screening of depression during PEG- IFN-α self-assessment scale was equally reliable as observer-based assesment of depressive symptoms. Common clinical parameters- subject related risk factors (age (p=0.955 ), sex (p=0.008), lifetime psychiatric disorder (p=0.656)), illness related risk factors (duration of CHC (p=0.267), i.v drug aplication as way of transmission (p=0.292)) and therapy-related risk factors (recommended duration of PEG-IFN-α (p=0.993) and dose of PEG-IFN-α (p=0.841)) were not significantly associated with depressive symptoms on PEG-IFN-α. Conclusions: Liason-consultation services should collaborate with hepatologists in creating screening programmes, supplemented by objective criteria and guidelines, for early recognition and treatment of interferon-induced depression. © Medicinska naklada.

Background: Tianeptine, a new generation antidepressant, possesses a unique mechanism of antidepressive action and has a specific pharmacokinetic profile. The aim of this study was to determine the efficacy, tolerability and safety of tianeptine in a "fragile" population of depressive patients: (1) a group of elderly patients and (2) a group with comorbid alcohol addiction. Subjects and methods: This was an open multicentric eight-week study of tianeptine efficacy, tolerability and safety including patients with mild to moderate depression (DSM-IV), age ≥55 years (group 1; n=45) or with comorbid alcohol addiction (group 2; n=32). Assessments was made with the following rating scales; MADRS, HAM-A and CGI for efficacy and DESS for tolerability. Results: After eight-week tianeptine therapy, remission (MADRS ≤12) was established in 51.1% and 84.4%patients, respectively. On day 7, the therapy led to a significant decrease of MADRS. On endpoint, there were significant differences on HAM-A, CGI-I and CGI-S scores (p<0.01). No adverse effects with frequency ≥ 10%, were registered. A lower tolerability of tianeptine was registered in a group of elderly (nausea 4.5%, leg fatigue 4.4%, irritability 2.2%, bursts of crying and sadness 2.2%), while only 3.1% depressive patients with comorbid alcohol addiction had dizziness. Conclusion: This is the first clinical study to evaluate tolerability, efficacy and safety of tianeptine in a special population of depressive patients in the region. The study showed that tianeptine had good efficacy in treatment of mild to moderate forms of depression in special populations of depressive patients (elderly population and patients with comorbid alcohol addiction). The drug was well tolerated. © Medicinska naklada.

Background/Aim. Antidepressants are a widely used class of drugs. The aim of this study was to investigate different aspects of antidepressant prescribing practice at University Psychiatric Clinic in Belgrade. Methods. This cross-sectional study was carried out by retrospective analysis of the patient's medical charts. The study included all patients with antidepressant prescribed at discharge during 2009 (n = 296). The evaluation was focused on patient- related factors (socio-demographic and illness related), psychiatrist-related factors (sex and duration of working experience) and drug related factors (type of antidepressant, dose, polypharmacy and reimbursement by national health insurance). Results. Antidepressants were prescribed for unipolar depression (F32-34, ICD X) either without comorbidity (46.2%) or with comorbidity (24.7%), mostly as a monotherapy (91% had one antidepressant), to the patients who were 65% female, aged 50.1 ± 8.9, most of them with 12 years of education (52.6%), married (69.3%) and employed (55.9%). The majority of patients had a history of two hospitalizations (Med 2; 25th-75th perc. 1-4) during nine years (Med 9; 25th-75th perc. 2-15) after the first episode of depression. Among them, 19% were found to be suicidal in a lifetime. The single most prescribed antidepressant was sertraline (20.4%), followed by fluoxetine (13.3%) and maprotiline (11.7%). Utilization of antidepressants was positively correlated with the rate of reimbursement (p < 0.01). The most prescribed antidepressant group was selective serotonin reuptake inhibitors (SSRI) (47.8%), followed by tricyclic antidepresants (TCA) (25.3%) and new antidepressants - venlafaxine, tianeptine, mirtazapine, bupropion, trazodone (15.1%). Most of the drugs were prescribed in doses which are at the lower end of the recommended dose-range. Regarding severity of the actual depressive episode, TCA were prescribed for severe depression with psychotic features, while SSRI were choice for episodes with moderate symptom severity (p = 0.01). Psychiatrists with longer working age (20-30 years) hesitated to prescribe new antidepressants in comparison to younger colleagues (p = 0.01). Conclusion. Economic issues in Serbia as developing country influence the choice of antidepressants, as well as a psychiatrist's working age and severity of depression. However, SSRI are the drugs of the first choice, as it was shown in most of the developed countries nowadays.

Background: During the COVID-19 pandemic health care providers found themselves under increased demands in the work environment and in their professional and personal lives which created both physical and mental health challenges. Thus, we aim to provide an integrative review that identifies and summarizes the research published regarding mental health functioning in health care providers, in Serbia, since the beginning of the pandemic. Subjects and methods: A search of the published literature was conducted using Medline and SCIndex databases, applying key words “COVID-19” and “Serbia”. The search was limited to papers published since the beginning of the COVID-19 pandemic until January 2022. Two reviewers independently screened the retrieved papers. The study used pre-defined inclusion and exclusion criteria. Results: We identified eight papers on the subject of mental health functioning in health care providers. The studies were all original research papers with predominantly cross-sectional study design, using online assessments. Sample size varied in number of participants and profile of medical providers (physicians, nurses and medical technicians, community pharmacists). Dominantly, focus of interests of researchers were exploration of levels of anxiety, depression, sleep disturbances, burnout, as well as behavioural changes and environmental influences. Conclusions: The studies related to mental health of medical professionals show the importance of recognizing the psychological challenges posed by health crises caused by COVID-19. They raise awareness of recognizing differences and difficulties between wide range of medical sectors, and appeal for necessity for accessible and professional psychological support. Further studies should address the detailed exploration of the mental health of this specific population, as well as propose strategies needed to balance the challenges posed by the pandemic. © Medicinska naklada - Zagreb, Croatia.

Background: The purpose of the study was to research gender differences in suicides committed in Podgorica between 2000 and 2006, including sociodemographic variables (e.g. age, marital status, education etc.), methods of and motives for committing suicide. Data were taken from the Police Directorate of Montenegro. Subjects and methods: We used data on 220 males and 83 females who committed suicide. Statistical analysis was done by using the crude specific rate. Significance between two independent crude rates is constructed around their 95% confidence intervals and it utilizes the difference between the two rates (D) to determine significance. Results: The incidence of suicide in males was found to be higher than infernales (the male to female suicide ratio is 2.6 to 1). Females were older than males. Females had completed elementary education more frequently, and they were single or divorced or widows. Males had completed secondary education more frequently and they were married. The most frequent employment status of both gender groups implied pensioner and unemployment statuses. There was a significant difference in suicide rates between the genders during the reporting period. Suicide rates increase with age in both genders. Males chose firearms, hanging, strangulation and suffocation and jumping. Females chose hanging, strangulation and suffocation, jumping and drowning as the most frequent methods of suicide. The most frequent motive for suicide in both gender groups was physical illness. The second most frequent motive was mental illness. Emotional and financial difficulties were motives which were more common in males, whereas family problems appeared to be motives two times more frequent infernales. Conclusions: The complex multifactorial etiology of suicide suggests the need to consider gender differences when developing effective strategies for the therapy and the prevention of suicide. © Medicinska naklada.

Background: Taking the Initiative to evaluate students' affinity toward psychiatry seems to be a global issue and is an essential part of programs to improve the status of the profession. The aim of this study is to explore medical students' attitudes toward psychiatry in comparison to other residencies (internal medicine, surgery, pediatrics, gynecology and general medicine) in the pre-clinical year and to observe which factors influence the creation of these attitudes. Subjects and methods: The survey included 114 students of the second year, School of Medicine in Belgrade (academic year 2007/08). The data was collected trough a 23-item questionnaire. Results: Fifteen percent of students stated that psychiatry was their career of choice, while 25% expressed a strong aversion. Psychiatry was ranked less attractive than internal medicine, surgery and pediatrics, but more attractive than general medicine or gynecology. Those who like psychiatry attributed more importance to an interesting and challenging job than to prestige and financial reward. Also, they found this field to be intellectually challenging and to rapidly expand the frontier of medicine. Students with negative attitude were convinced that psychiatry was lacking in scientific foundation and was clinically inefficient, they disliked intensive emotional involvement, exposure to stress and frequent unpleasant situations and had prejudices toward the patients or simply a lack of the interest. Conclusion: The present study is the first of its kind in Serbia which used a precise and internationally comparable methodological instrument and It shows that pre-clinical medical students at the University of Belgrade, have a stronger affinity towards psychiatry when compared to their peers from most countries worldwide. Also, the study points out the fact that prejudices toward patients with mental dysfunctions and lack of confidence in the efficacy of psychiatric treatment should be specially targeted by the curriculum in the later part of undergraduate education. How this will affect the attitude of clinical students and graduates is to be examined. © Medicinska naklada.

Background: The aim of this study was to investigate the influence of certain psychosocial factors - insight, psycho-education, family and social support, loneliness and social isolation - on the appearance of depression and suicidal risk in schizophrenia. Subjects and methods: This was a cross-sectional study that comprised hospitalized patients with schizophrenia in the initial remission phase. The assessment of depression and suicidal risk was made by applying a semi-structured psychiatric interview that included scrutinized factors (insight, psycho-education, family and social support, loneliness and social isolation), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale for Schizophrenia (CDSS). On the basis of the assessment results, the sample was divided into two groups: Group of patients with depression and suicidal risk in schizophrenia (N=53) and Control group (N = 159) of patients with schizophrenia without depression and suicidal risk. Results: In the Group of patients with depression and suicidal risk, compared with the Control group, there was significantly higher frequency of insight in the mental status (χ2=31.736, p<0.001), number of patients without psycho-education (χ2=10.039, p=0.002), deficit of family support (χ2=13.359, p=0.001), deficit of social support (χ2=6.103, p=0.047), loneliness (χ2=6.239, p=0.012), and social isolation (χ2=47.218, p<0.001). Using the model of multi-variant logistic regression, insight, deficit of psychoeducation and social isolation (p<0.05) were identified as predictors of depression and suicidal risk in schizophrenia. Conclusions: This study shows that considered psycho-social factors - insight in the mental status, lack of psycho-education, as well as social isolation - could be predictors for appearance of depression and suicidal risk in schizophrenia. © Medicinska naklada.

Background: The attitudes of medical professionals towards homosexuals can influence their willingness to provide these individuals with medical help. The study evaluated the medical professionals' knowledge about homosexuality and their attitudes towards it. Subjects and methods: The sample consisted of 177 participants (physicians n=79 and students n=98). The study respondents anonymously completed three questionnaires (socio-demographic questionnaire, the questionnaire on knowledge, and the questionnaire on attitudes towards homosexuals). Results: Male and religious participants showed a lower level of knowledge and a greater tendency to stigmatize. Furthermore, the subjects who knew more about homosexuality tended to hold less stigmatizing attitude. Age group, specialty (psychiatry, gynecology, internal medicine and surgery), and student's/physician's status had no effect on stigmatization. The study showed that the final year students/ residents had more knowledge than the second year students/specialists did. Knowledge had significant negative predictive effect on attitudes in the analyzed predictive model. Conclusions: To our knowledge, this has been the first study in Serbia and Eastern Europe, which provides information on knowledge and attitudes of health professionals towards homosexuality. We would like to point out the degree of knowledge on homosexuality as a possible, but not exclusive tool in shaping the attitudes towards homosexuals and reducing stigmatization. However, regardless of the personal attitude, knowledge and variable acceptance of the homosexuals' rights, medical professionals' main task is to resist discriminative behavior and provide professional medical help to both homosexual and heterosexual patients. © Medicinska naklada.

A hundred years after psychoanalysis was introduced, neuroscience has taken a giant step forward. It seems nowadays that effects of psychotherapy could be monitored and measured by state-of-the art brain imaging techniques. Today, the psychotherapy is considered as a strategic and purposeful environmental influence intended to enhance learning. Since gene expression is regulated by environmental influences throughout life and these processes create brain architecture and influence the strength of synaptic connections, psychotherapy (as a kind of learning) should be explored in the context of aforementioned paradigm. In other words, when placing a client on the couch, therapist actually placed client's neuronal network; while listening and talking, expressing and analyzing, experiencing transference and counter transference, therapist tends to stabilize synaptic connections and influence dendritic growth by regulating gene-transcriptional activity. Therefore, we strongly believe that, in the near future, an increasing knowledge on cellular and molecular interactions and mechanisms of action of different psycho- and pharmaco-therapeutic procedures will enable us to tailor a sophisticated therapeutic approach toward a person, by combining major therapeutic strategies in psychiatry on the basis of rational goals and evidence-based therapeutic expectations. © Medicinska naklada.

Introduction: Eating disorders indicate unhealthy habits in nutrition and/or behaviour in the feeding and maintaining of body weight. The main characteristic of these diseases is changed behaviour in nutrition, either as an intentional restriction of food, namely extreme dieting or overeating, i.e. binge eating. Extreme dieting, skipping meals, self-induced vomiting, excessive exercise, and misuse of laxatives and diuretics for the purpose of maintaining or reducing body weight are the forms of compensatory behaviour. Objective: The purpose of the present research was to determine the presence of different inappropriate compensatory behaviours among eating disordered patients. Methods: The experimental group included 35 female eating disordered patients of 23.02±3.46 years on average, with anorexia or bulimia nervosa. The control group consisted of 70 girls aged 23.1±3.0 years on average. Each participant completed a "24-hour Recall Questionnaire" and the "Eating Disorder Diagnostic Scale". Results: A high statistically significant difference existed in the presence of all compensatory behaviours in the experimental and control group, regarding vomiting (χ2=40.6; p<0.001), misuse of laxatives and diuretics (χ2=33.7; p<0.001), extreme dieting (χ2=23.4; p<0.001) and excessive exercising (χ2=27.1; p<0.001). Conclusion: Eating disordered patients showed a significantly higher incidence of all evaluated forms of compensatory behaviour in comparison with the control group. This report confirms the presence of specific symptomatology of anorexia and bulimia patients.

Background: Type 2 diabetes (T2DM) doubles the odds of comorbid depression. Depression is a strong predictor of developing T2DM. The aim of the study was to compare depressed patients with T2DM to non-depressed ones with respect to demographic, psycho-social, clinical, anthropometric and metabolic characteristics; to examine the relationship between glycemic control and depression severity in depressed patients; to estimate the risk factors of depression. Subjects and Methods: A group of depressed diabetic patients comprising those with a Major depressive episode, first or repeated (ICD-10; 1992) and endocrinologist-diagnosed T2DM, duration ≥5 years on oral, insulin therapy or both (N=46) and non-depressed ones (N=44) (90 in total) of both genders (<65 years) were included in this cross-sectional study. Laboratory and non-laboratory measures were performed.. The patient Health Questionnaire (PHQ-9) and a structured interview (MINI) were used to establish diagnosis, while the Beck Depression Inventory (BDI; cut off ≥16) was used to assess the severity of depression. Scaling of Life Events (SLE) for self-assessment of life events and Problem in Areas in Diabetes (PAID) for self-assessment of diabetes distress were also performed. Results: Statistically significant higher rates of psychiatric heredity, neuropathy, higher level of diabetes related distress and a greater number of life events in depressed patients compared to non-depressed ones were found. There was a statistically significant positive correlation between BDI somatic subscore and the HbA1c level (r=0.343; p=0.020). The level of diabetes related distress (OR=1.084; p=0.000), total number of life events (OR=4.528; p=0.001) and neuropathy (OR=8.699; p=0.039) were statistically significant predictors of depression using logistic regression. Conclusions: The results obtained showed that depression in diabetic patients was predicted by both psychological (diabetes related distress, life events) and disease-specific variables (neuropathy). The severity of self-reported somatic depressive symptoms significantly correlated with the HbA1c level in depressed diabetic patients. © Medicinska naklada.

Backround: Stigmatization of psychiatric patients is present both in the general population and among healthcare professionals. Aim: To determine the attitudes and behaviour of medical students towards a person who goes to a psychiatrist, before and after psychiatric rotation, and to compare those attitudes between medical and non-medical students. Methods: The study included 525 medical students (second and sixth year of studies) and 154 students of law. The study instrument was a three-part self-reported questionnaire (socio-demographic data, Rosenberg Self-Esteem Scale and a vignette depicting a young, mentally healthy person). The experimental intervention consisted of ascribing a psychiatric label to only one set of vignettes. All the vignettes (with or without the psychiatric label) were followed by 14 statements addressing the acceptance of a person described by vignette, as judged by social distance (four-point Likert scale). Results: Higher tendency to stigmatize was found in medical students in the final year, after psychiatric rotation (Z U = ?3.12, P = .002), particularly in a closer relationship (Z U = ?2.67, P = .007) between a student and a hypothetical person who goes to a psychiatrist. The non-medical students had a similar tendency to stigmatize as medical students before psychiatric rotation (Z U = ?0.03, P = .975). Neither gender, nor the size of students place of origin or average academic mark was associated with the tendency to stigmatize in our sample. However, students elf-esteem was lower in those with a tendency to stigmatize more in a distant relationship (P = ?0.157, P = .005). Conclusions: Psychiatric education can either reinforce stigmatization or reduce it. Therefore, detailed analyses of educational domains that reinforce stigma will be the starting point for anti-stigma action. © The Author(s) 2011.

A rapid expansion of new treatment options in recent decades and the increasing volume of scientific evidence published on a daily basis have been followed by the necessity of introduction of clinical guidelines and therapeutic algorithms. The development of these guidelines and algorithms has also been driven by increased cost-awareness and the increasing pressure to improve cost-efficiency. The Serbian Physicians Society published "Therapeutic Guidelines for the Treatment of Schizophrenia" in 2003 and "Therapeutic Guidelines for the Treatment of Bipolar Affective Disorder" in 2004. The School of Medicine, University of Belgrade published "Therapeutic Guidelines for the Treatment of Depression" in 2004. All of these national guidelines, at the moment of development, were based upon up-to-date scientific evidence. According to the recently conducted survey at the Institute of Psychiatry, Clinical Centre of Serbia, about 65% of psychiatrists stated that they adhere to the national or relevant international therapeutic guidelines. When asked to cite which international or foreign guidelines in particular they used, approximately 50% failed to do so, while the other half cited mostly the APA Guidelines or NICE Guidelines. Among the national guidelines, physicians are, according to the survey, familiar with the Therapeutic Guidelines for the treatment of Schizophrenia (46,3%), Therapeutic Guidelines of Depression (41,5%) and Therapeutic Guidelines for the Treatment of Bipolar Affective Disorder (34,1%). The majority of Serbian psychiatrists rely on the efficacy and safety of the drugs as the major determining factors in the choice of therapy, bearing in mind the patients' best interests. However, it is unclear why such a discrepancy between practice and guidelines still persists, since guidelines also recommend therapy based on their safety and efficacy data. It is possible that a substantial percentage of psychiatrists obtain indicators on drugs' efficacy and safety from their personal professional experience. It is doubtful whether this knowledge is valid, or just represents unproven prescribers' habits. Furthermore, the influence on other factors, such as treatment costs or drug availability should be further investigated. © Medicinska naklada.

[No abstract available]