Background/Objectives: Alexithymia is a condition marked by difficulties in identifying and expressing emotions, rooted in both physiological and behavioral mechanisms. The aim of this study was to investigate the relationship between parental alexithymia and family functioning in families of children with Autism Spectrum Disorder (ASD) compared to families of typically developing children (TD). Methods: The study sample included parents of children with ASD (n = 120) and a control group of parents of typically developing children (n = 120). A comprehensive set of self-report instruments was used to evaluate alexithymia levels, parental stress, family experience, resilience, cognitive emotion regulation, social support, and family flexibility and cohesion. Results: The analysis revealed that parental alexithymia in families of children with ASD was directly associated with lower levels of family flexibility and cohesion, independent of increased stress or reduced family resilience. Furthermore, the findings indicate that alexithymia in parents is directly linked to reduced family cohesion in ASD families. Conclusions: These results highlight the significant role of parental alexithymia in shaping family dynamics and underscore the necessity for targeted interventions that emphasize emotional skill-building, adaptive coping mechanisms, and resilience to stressful events. This research enhances the understanding of parental alexithymia’s effect on family functioning in the context of ASD.

Introduction Parkinson’s disease (PD) is the most common serious movement disorder in the world, affecting about 1% of adults older than 60 years. The disease is attributed to selective loss of neurons in the substantia nigra, and its cause is enigmatic in most individuals. Patients with PD display both motor and non-motor symptoms. For some patients, the non-motor symptoms are more bothersome than the motor symptoms. One of the most common non-motor symptoms of PD is depression. Objectives Treatment of depression with antidepressant drugs is well established. In the last 20 years use of antidepressant has risen mainly due to the introduction of the selective serotonin reuptake inhibitors (SSRIs). Our primary aim was to demonstrate an improvement in depressive symptoms in patients who started treatment with vortioxetine. A secondary aim was to show those who was successfully treated with vortioxetine but was unresponsive to paroxetine and escitalopram without worsening the extrapyramidal symptoms of PD. Methods In collaboration with the Department of Neurology, we included patients who are being treated for Parkinson’s disease and who meet the criteria for depressive disorder after a psychiatric examination. We divided the patients into two groups: those who had not previously taken any antidepressant drugs and those who were already on therapy with paroxetine and escitalopram but without the expected therapeutic response. All patients were prescribed vortioxetine in their treatment, and the Hamilton Depression Rating Scale (HDRS) was determined during their first meeting with the psychiatrist, and then again after 6 weeks of taking the medication. Also, we used Mini mental state examination (MMSE) to measure cognitive impairment.Our primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS) Results Our primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS) Conclusions In our research, vortioxetine has proven to be effective in treating depressive symptoms without worsening Parkinson’s disease, unlike paroxetine and escitalopram, which resulted in partial effects. Disclosure of Interest None Declared

Background: Parkinson's disease (PD) is the most common movement disorder globally, affecting approximately 1% of adults aged over 60 years. The disease is linked to the selective loss of neurons in the substantia nigra. PD patients exhibit both motor and non-motor symptoms, with non-motor symptoms sometimes proving more troublesome than motor symptoms. Depression stands out as one of the most common non-motor symptoms in PD.

Introduction Treating young patients with schizophrenia is a challenge, as these patients have much to gain from controlled pharmacotherapy and even more to lose with a possible relapse. Treating patients with long-acting injectable antipsychotics avoids the issue of non-compliance, the biggest risk factor for relapse, while also improving the quality of life. Receiving a drug once-a-month can provide greater flexibility and convenience to our patients. Objectives Aim of the paper is to assess the efficacy and quality of life in monthly dosing of long-acting injectable antipsychotic in young adult schizophrenia patients. Methods The research included 7 patients aged 19 to 25 years who were diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients were assessed eight times over two years using the following clinical scales: Positive and Negative Syndrome Scale, Clinical Global Impression – Severity and Improvement Scale, Treatment Satisfaction Questionnaire for Medication (TSQM-9) and Quality of Life Scale (QOLS). Results All treated patients achieved remission. There was a statistically significant improvement in measured scales in all patients. There were no side-effects reported during the study period, with no relapse or new hospitalizations Conclusions The monthly formulation of aripiprazole has proven to be effective and safe in our study and has great potential to improve patient quality of life as well. Disclosure of Interest None Declared

Aim: To report the clinical courses of four adolescent patients, who developed childhood-onset schizophrenia and where art had a vital role in diagnosing schizophrenia, monitoring their clinical state and progression. Case report: All of the patients had several diagnoses throughout childhood; however, the final diagnosis was made with the help of art therapy. Following the changes in the content of our patients' drawings enabled us to notice the changes in their quality of life, functioning, and efficacy of therapy. Some of the patients specified that throughout the drawing process, they felt more satisfied, “better” and not „haunted„ by their hallucinations. This acknowledgment assured us that creative expression through art is an appropriate approach for them. It also strengthened the therapeutic relationship with our patients and encouraged us to understand their disease and make better decisions about their treatment. Conclusions: We propose art as an assistive method in diagnosing schizophrenia. Art can break down communication barriers and can also serve as follow-up method for children and adolescent patients with schizophrenia.

Background and objectives: The role of coping mechanisms and alcoholism in people affected with malignant tumours of oral cavity and oropharynx is not clearly established in literature. The aim of this study was to compare the coping strategies of the alcohol dependent patients affected by the malignant tumours of oral cavity and oropharynx with the alcohol dependent patients who were not affected by the carcinoma and the healthy population. Methods: The study included a total of 153 participants divided into three groups matched in age, gender, education, work and marital status. The first group consisted of 51 alcohol dependent patients diagnosed with malignant tumour of the oral cavity and oropharynx who had been hospitalised and undergone surgery. The second group included 51 patients diagnosed with alcohol dependence but with no cancer diagnosis and the third group consisted of 51 participants who had not previously had any health problems. All participants completed the self-assessment test aimed at registering their usual strategies of coping with stress. Results: The three groups of patients differed most in avoidance coping, both on the total score (F-(2,F-150) = 3,986; p = 0.021) and the following subscales: accepting (F-(2,F-150) = 5,509; p = 0.005), mental disengagement (F-(2,F-150) = 4,017; p = 0.020), religion (F-(2,F-150) = 4,527; p = 0.012), alcohol/drug consumption (F-(2,F-150) = 11,825; p < 0.001) and isolation (F-(2,F-150) = 3,448; p = 0.034). Compared to healthy controls, patients diagnosed with malignant tumour and alcohol dependence used more avoidance in coping with stress (p = 0.010). Conclusion: Despite the limited generalisation and cross-sectional study design the results indicated that patients affected by alcohol dependency and malignant tumour of oral cavity and oropharynx perceived their illness as something out of their control, something that they can hardly deal with, and mostly relied on disengaging/distancing coping strategies. (C) 2020 Asociacion Universitaria de Zaragoza para el Progreso de la Psiquiatria y la Salud Mental. Published by Elsevier Espana, S.L.U. All rights reserved.

Poremećaj iz spektra autizma (engl. autism spectrum disorder, ASD) neurorazvojni je poremećaj kojeg obilježavaju kvalitativne anomalije u društvenoj interakciji i u modalitetima komunikacije koje su popraćene ograničenim, ponavljajućim i stereotipnim repertoarom interesa i aktivnosti te nejednolikim intelektualnim razvojem. Uzrok autizma se ne zna. Smatra se kako je riječ o multifaktorijalnom poremećaju, a povezuje se s genetskim i okolišnim čimbenicima. Svrha rada jest dati pregled znanstvene i stručne literature na temu utjecaja djeteta s autizmom na obitelj. Roditelji se moraju suočiti s postavljenom i teško prihvaćenom dijagnozom te je moraju prenijeti ostalim članovima obitelji. Potrebna je prilagodba novom načinu života. Proces prilagodbe, prihvaćanja i privikavanja je dugotrajan, a kod nekih roditelja traje cijeli život. Obitelj poprima novu ulogu, čiji je glavni cilj podizanje djeteta i preuzimanje pune odgovornosti za dijete koje ovisi o angažmanu vlastite obitelji. Uočena je viša stopa razvoda kod roditelja, negativni utjecaji kroničnog stresa i izoliranje iz zajednice. Negativan se utjecaj uočava i kod braće i sestara djece s autizmom. Od izrazite je važnosti edukacija roditelja. Često se roditelji u procesu prihvaćanja počinju educirati i sudjelovati aktivno u grupama podrške i prosvjećivanju zajednice te zagovaranju za svoje dijete.

Introduction. Day hospitals are becoming an increasingly common method of treatment for people with mental disorders in many Croatian psychiatric hospitals, but research examining their effectiveness is still rare.Aim. The aim of this study was to compare treatment satisfaction and quality of life between patients enrolled in a day hospital program and patients hospitalized on a psychiatric ward.Methods. The study design was cross-sectional with two outcome measures: treatment satisfaction and quality of life. The study sample consisted of 120 adult patients of the Clinic for Psychiatry of the University Hospital Centre Rijeka. The first group consisted of 60 patients included in the day hospital psychosocial program, while the second group consisted of 60 patients hospitalized on the inpatient ward.Results. Day hospital patients reported a significantly higher level of overall treatment satisfaction compared to hospitalized patients (mean rank: 55 vs. 17, p=0.000) and were significantly more satisfied in four out of seven different treatment domains: the explanations about treatment (mean rank: 68 vs. 53, p=0.013), carefulness and precision of medical examination (mean rank: 72 vs. 49, p=0.000), choices about treatment (mean rank: 67 vs. 57, p=0.027) and feeling of respect (mean rank: 68 vs. 53, p=0.010). Day hospital patients also reported a significant psychopaly higher level of overall subjective quality of life (mean: 4.26 vs. 3.71, p=0.005), being more satisfied with life in general (mean rank: 68 vs. 53, p=0,018), financial situation (mean rank: 67 vs. 54, p=0.046), accommodation (mean rank: 67 vs. 54, p=0.041), personal safety (mean rank: 68 vs. 53, p=0.014), people they live with or living alone (mean rank: 71 vs. 50, p=0.001), relationship with their family (mean rank: 49 vs. 53, p=0.000) and their mental health (mean rank: 69 vs. 52, p=0.008).Conclusion. Patients treated in the day hospital differed in the observed variables from those hospitalized on the ward, reporting higher levels of treatment satisfaction and higher subjective quality of life. Future studies should focus on different segments of day hospital programs and a broader set of outcomes.

Granicni poremecaj osobnosti karakteriziran je pervazivnim simptomima nestabilnosti u međuljudskim odnosima, self-imageu i afektu, uz impulzivnost i znatne probleme s identitetom. Socijalno ponasanje tih bolesnika nestabilno je, kaoticno i kontradiktorno. Lijecenje granicnog poremecaja osobnosti predstavlja terapijski izazov buduci da navedena obilježja osobnosti tih bolesnika znatno utjecu na odnos prema psihoterapeutu kao i na odnose u grupnom settingu. U vrijeme kada su postavljeni dijagnosticki kriteriji za granicni poremecaj smatralo se da je rijec o poremecaju koji je neizljeciv. U međuvremenu je doslo do promjene u konceptu, stajalistima i psihoterapijskom pristupu. Istraživanja evaluacije psihoterapijskih postupaka za taj poremecaj dokazala su ucinkovitost mnogih od njih. Među njima je i grupna psihodinamicka psihoterapija. U odnosu na klasicni psihoanaliticki pristup u radu s tim bolesnicima danas se preferira veci angažman psihoterapeuta, ohrabrivanje, validacija i savjetovanje, tj. potice se intersubjektivnost i enactment, osobito na pocetku lijecenja kad je anksioznost preplavljujuca i postoji opasnost od preranog prekida terapije. Nakon sto se postigne kohezija u grupi i razvije grupni matriks dolaze u obzir ekspresivne ili interpretativne intervencije. Buduci da je rijec o bolesnicima koji psihoterapeuta ne ostavljaju indiferentnim te mogu pobuditi snažne kontratransferne odgovore, potrebna je redovita supervizija. Cilj ovog rada jest teoretsko razmatranje i razumijevanje uloge grupne psihodinamicke psihoterapije u lijecenju granicnog poremecaja osobnosti.

BACKGROUND Many adolescents affected by psychiatric disorders require pharmacological treatment. Knowing which medication is being used is of utmost importance. Our main objective was to gain insight into prescribing patterns at the Department of child and adolescent psychiatry, Clinical Hospital Centre Rijeka. In addition, we looked for potential differences between adolescents regarding their pharmacotherapy status. SUBJECTS AND METHODS The data from medical charts of 227 adolescents (55% females), age 12-18 years (16.4±1.18) were analysed. All of them were treated as outpatients during one year period (2014/15). Medical charts were obtained from the computerized archive system of Clinical Hospital Centre. Prescribed drug patterns were taken into account if patients have been taking medication for at least one month. RESULTS Most of the patients, 162 (71.4%), were treated with psychiatric medication. In the pharmacologically treated group, adolescents were older (t=-4.678; p<0.001), predominately male (χ2=5.175, p=0.023) and hospitalized (χ2=20.612, p<0.0001). Accordingly, male (OR=2.09, P<0.05) and hospitalized (OR=15.32, P<0.001) adolescents were more disposed to be medicated. Psychotic disorder was the most commonly diagnosed disorder (51 patients). There were 454 different prescribing patterns, mostly prescribed antipsychotics, 36.6% of all prescriptions; followed by 31.5% anxiolytics' and 23.7% antidepressants' prescriptions. However, number of patients receiving antipsychotics, anxiolytics and antidepressants was quite similar (103: 110: 99). The highest number of patients was treated with sertraline (58), followed by those treated with risperidone (48). Majority of the patients (104/227) were treated with polytherapy. CONCLUSION Prescribing psychiatric pharmacotherapy for adolescents is a common clinical practice. Adolescents that were prescribed pharmacotherapy were significantly older; hospitalized and male adolescents were more prone to be medicated. Antipsychotics were most frequently prescribed drugs. The prescribing patterns are generally consistent with international trends and guidelines; however caution regarding high proportion of polytherapy is necessary.

Background: Even though there is a growing interest in the neurophysiology of yawning, it still remains somewhat of a scientific mystery due to the fact that we still do not know the exact mechanisms behind it.Apart from physiological yawning, abnormal and excessive yawning has been observed in numerous pathologies, mostly in neurological and psychiatric disorders, as well as side effects of various medicaments.Subject: We will present the case of a 42 year old woman who developed excessive yawning as a side effect of treatment with sertraline.Discussion: Although we still do not know the exact mechanism behind yawning, several neurotransmitters and neuropeptides are thought to be involved in the neurophysiology of yawning, especially serotonin and dopamine.Subsequently, excessive yawning has been observed in some patients treated with the majority of novel serotonergic antidepressants.Conclusion: Excessive yawning requires the same clinical attention as other side effects of antidepressant treatment and therefore should be carefully considered and managed.Intolerance to antidepressant treatment is a significant cause of treatment failure and that is why psychiatrists should keep in mind that sertraline could cause such a disabling side effect as excessive yawning.

OBJECTIVE:The aim of this study was to explore the effectiveness and tolerability of long-acting paliperidone palmitate antipsychotic in adolescent first-episode schizophrenia patients while comparing the results with the oral antipsychotic risperidone.METHODS:This study is a retrospective, noninterventional study to assess the effectiveness and tolerability of long-acting injectable antipsychotic paliperidone palmitate in first-episode adolescent patients during the first 12 months of treatment compared with the oral antipsychotic risperidone. The data include general sociodemographic characteristics, number of hospitalizations, side effects, and the following clinical scales: Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale (PSP), Clinical Global Impression Improvement and Severity (CGI-I and CGI-S), and Treatment Satisfaction Questionnaire for Medication (TSQM).RESULTS:During the 12-month study period significant improvement was registered in patients receiving both paliperidone palmitate and risperidone in the following scales: PANSS, PSP, CGI-I, and CGI-S. Patients receiving paliperidone palmitate had significantly greater improvement in PANSS, CGI-S, and PSP compared with the risperidone group. Patients receiving risperidone had significantly higher number of hospitalizations than the patients receiving paliperidone palmitate. The TSQM revealed that the patients who were receiving paliperidone palmitate achieved significantly higher scores on the convenience scale, global satisfaction, and on the overall result, whereas no difference was observed on the effectiveness scale. There were several side effects reported for paliperidone (5.5% hyperprolactinemia, 5.5% weight gain) and risperidone (5.5% hyperprolactinemia, 16.7% weight gain).CONCLUSIONS:In conclusion, paliperidone palmitate seems to be safe and effective in adolescent patients. Furthermore, it compared favorably with risperidone in the clinical response, side effects, and hospitalizations.

U poglavlju je opisano kako su izrađene smjernice za lijecenje osoba sa dusevnim poremecajima na inicijativu Hrvatskog psihijatrijskog drustva.Opisana je metodologija rada kao i skupine mentalnih poremecaja za koje su izrađene smjernice.