Psychomotor agitation is a state of motor restlessness and intrapsychic tension that requires fast recognition and adequate assessment and management to minimize patient anxiety and reduce the risk for escalation to aggression and violence. It may be caused by a variety of psychiatric conditions (psychotic disorders, intellectual disability, autism, affective and anxiety disorders, personality disorders), substance abuse and/or intoxication or withdrawal and a wide range of general medical conditions. Numerous factors influence the final decision on the choice of adequate pharmacotherapy, such as clinical presentation, compliance, age, sex, comorbidities and the availability of certain drugs that are indicated in the management of psychomotor agitation. Since clinical practice is frequently based on medications or their combinations, as well as the routes of administration that are not supported by existing evidence coming from research, we conducted a multi-centric investigation in which we included Croatian psychiatrists working in acute wards, since they are the ones caring for the majority of patients presenting with agitation. For this purpose, we created a questionnaire consisting of 13 questions related to the pharmacological treatment of agitation in terms of the most commonly used medications, their route of administration, combinations and adverse effects. The results of this research will serve as a basis for the development of a Croatian protocol for the pharmacological treatment of patients presenting with severe agitation.

Background Previous studies have identified substantial unmet information needs in people with depression and anxiety. Sufficient information about the disorder, treatment, available services, and strategies for self-management is essential as it may influence quality of care and patients’ quality of life. This scoping review aimed to provide a broad overview of information needs of people with depression and anxiety as well as the sources that they use to seek this information. Methods We included all primary research published in English that investigated information needs or information sources in people with depression or anxiety, with no restrictions imposed on the study design, location, setting, or participant characteristics. Six electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, LISTA, Web of Science) and the grey literature (Google and Google Scholar) were searched for relevant studies published up to November 2021. Two reviewers independently screened articles and extracted data. Narrative synthesis was performed to identify key themes of information needs and information sources. Factors associated with information needs/sources such as demographic variables and symptom severity were also identified. Results Fifty-six studies (comprising 8320 participants) were included. Information needs were categorised into seven themes, including general facts, treatment, lived experience, healthcare services, coping, financial/legal, and other information. The most frequently reported needs in both people with depression and anxiety were general facts and treatment information. Subclinical samples who self-reported depressive/anxious symptoms appeared less interested in treatment information than patients with clinical diagnoses. Information sources were summarised into five categories: health professionals, written materials, media, interpersonal interactions, and organisational resources. Health professionals and media (including the internet) were the most frequently adopted and preferred sources. Although few studies have examined factors associated with information needs and information sources, there is preliminary evidence that symptom severity and disease subtypes are related to information needs/sources, whereas findings on demographic factors were mixed. Conclusions Information needs appear to be high in people with depression and anxiety. Future research should examine differences between subgroups and associated factors such as the treatment course. Personalised information provision strategies are also needed to customise information according to individual needs and patient profiles. Trial Registration The protocol of this scoping review was registered on Open Science Framework (OSF; link: https://doi.org/10.17605/OSF.IO/DF2M6 ).

Delusional infestation (DI) is a rare psychiatric disorder characterized by a persistent false belief that one is infected with nonliving or living pathogens, usually accompanied by formication. Other psychotic features, such as disorganized speech or hallucinations unrelated to the core delusion itself, are never present, and the delusional belief does not extend into other areas of life. Secondary DI, when one needs to address the underlying condition in order to achieve adequate treatment, is also possible. We present the case of a 42-year-old male with a 2-year history of having a persistent and firm belief that his house was infested with tiny insects that were constantly biting him and laying their eggs under his skin. His delusional belief was preceded by a complex, years-long substance use disorder, which confronted us with a differential diagnostic dilemma between primary and secondary DI. He was successfully treated with olanzapine pamoate depot, which was introduced to address his lack of insight and unsatisfactory compliance, and his delusion faded away after his symptoms subsided.

The objective of this systematic review is to reflect on assumptions in relation to codeine use in combination with other analgesics. MEDLINE was searched according to the predetermined keywords and criteria. Only English language studies were taken into consideration and the outcome data of the final studies were extracted by two reviewers independently from each other and were checked by the third reviewer. Additionally, the available codeine-related Individual Case Safety Reports (ICSRs) retrieved from EudraVigilance were reviewed. Sixteen placebo-controlled studies that involved 3378 subjects suffering from acute pain were analyzed for the efficacy of low-dose codeine (≤ 30 mg) combination products. Twelve of them found low-dose codeine combinations more efficient in relieving pain than the assigned comparator. According to 20 randomized clinical trials which included at least one dose of codeine (from 30 to 240 mg daily), the vast majority of reported side-effects were mild or moderate in severity. A total of 20 ICSRs for dependence were identified in the EudraVigilance database with codeine as a suspect drug for the 10-year time period for the European region. Low-dose codeine combinations are effective after a single application in treating acute pain. Codeine in doses ≤ 30 mg and higher was considered safe since only mild to moderate side-effects were observed. There is no indication in the available sources which clearly links low doses of codeine to substance use disorder in non-dependent subjects.

INTRODUCTION:The aim was to report the occurrence of after application of olanzapine long-acting injection (OLAI) in patients with schizophrenia during one year period.SUBJECTS AND METHODS:During one year period, OLAI was applied to 30 patients with schizophrenia (18 men, 12 women) who were non-adherent to previous treatment with oral olanzapine. Patients were 20-58 years of age (39 years old on average), diagnosed with SCID based on DSM-IV-TR criteria. Patients received OLAI in dosage between 210-405 mg (287±62 (mean ± SD)) every 2-4 weeks.RESULTS:Out of 30 patients that received OLAI, 29 patients improved significantly without side-effects, and one patient developed post-injection delirium/sedation syndrome (PDSS). The patient's somatic condition stabilized and treatment with OLAI was discontinued due to the PDSS.CONCLUSION:The occurrence of PDSS is not common and when it occurs, in our experience, it was reversible.

U radu autori, potaknuti nedavno održanim izborima za predsjednika Republike Hrvatske iznose postavke kontekstualno povezane s područjem ponašanja potrošača promatranih ovom prilikom iz perspektive glasača. Budući da je svakog korisnika usluge ujedno moguće terminološki odrediti i kao potrošača, tako je, analogno iznesenoj tvrdnji, a u okviru područja političkog marketinga, moguće svakog dionika demokratskog procesa glasovanja, odnosno glasača, definirati kao potrošača te u konačnici donositelja krajnje odluke — izići na biralište ili ne izići, glasovati za ili pak glasovati protiv. Pitanje koje se temeljem iznesenog u tom konkretnom slučaju nameće je priroda same motivacije glasača. Je li tu riječ o pozitivnoj ili negativnoj motivaciji glasača, o pozitivnoj ili negativnoj pokretačkoj sili? Jesu li glasači glasovali za ili su pak glasovali protiv? Ta je dilema, između ostalog, ujedno i posljedica mnogobrojnih tvrdnji koje je bilo moguće iščitati iz hrvatskih medija, a koje bi se mogle sažeti u zaključak da su glasači zapravo glasovali protiv, odnosno da su bili negativno motivirani te time izrazili svoje nezadovoljstvo postojećim socijalnim i ekonomskim stanjem u Republici Hrvatskoj te da nisu uzimali u obzir ponuđeni program kandidata. U radu se detaljnije opisuje kontekst motivacije kao pokretačke sile potrošača, odnosno glasača — tom prilikom u kontekstu političkog marketinga, te se navode i uspoređuju tri najpoznatije teorije potrošačke motivacije. Analizom postojećeg stanja i metodom komparacije navedenih teorija autori dolaze do zaključka o snažnijem utjecaju pozitivne motivacije na donošenje odluka glasača.

Permissibility of placebo controls in psychiatric research is raising everlasting controversies. The main ethical issue remains: whether, when, under what conditions, and to what extent is it justifiable to disregard subject's present (best) interest for the presumably "greater" ones. In relation to this main ethical concern, two distinct arguments arose: proponents of placebo controls trials (placebo ortxodoxy) and proponents of active controls trials (active-control orthodoxy). More recently, in new ethical guidelines, Declaration of Helsinki and International Ethical Guidelines for Biomedical Research Involving Human Subjects, a "middle way" approach was formulated, acceptable to both sides of the argument, saying placebo controls can be justified under certain conditions: when and only when, they firstly present undisputed methodological reasoning, and secondly, fulfill certain ethical considerations - mainly regarding the permissibility of accompanied risks. These ethical evaluations are inevitably contextual and evoke the need for the principle of proportionality. In scope of recent findings of substantial and progressively increasing placebo response in psychiatric research, contextual factors are identified and both theoretical and practical challenges are discussed.

Klinika za psihijatriju Vrapce obilježila je sredinom studenog 2014. godine 135 godina postojanja i rada. Za razliku od drugih hrvatskih psihijatrijskih bolnica, pa i psihijatrijskih odjela i klinika koji su u pravilu useljavali u prostore iz kojih su iseljavali atraktivni bolnicki odjeli, Bolnica Vrapce namjenski je građena za smjestaj i lijecenje psihijatrijskih bolesnika. Koncept rada bolnice bio je osmisljen i verificiran i prije pocetka njezine gradnje. Na tim se temeljima dograđuju sve kasnije dogradnje strucnih programa koji se provode u Bolnici. S obzirom na znacenje i mjesto Bolnice Vrapce u hrvatskoj psihijatriji, a ona je stožerna hrvatska psihijatrijska ustanova, dobro je, u kontekstu znanstveno-strucnog simpozija o izvrsnosti zdravstvenih ustanova ciji je osnivac Grad Zagreb, osvrnuti se s nekoliko recenica na neke momente iz povijesti ove Bolnice koja je u vlasnistvu Grada Zagreba, a koji su znacajni za sve ono sto se na strucnom, znanstvenom, edukacijskom pa i drustvenom i kulturnom planu, događalo i događa u Bolnici, odnosno po onom cime ona pokazuje svoju posebnost kojom prednjaci unutar sustava hrvatskog zdravstva.

This study provides an overview of the incidence of smoking, the socio-demographic characteristics of Croatian smokers during a five-year period and an assessment of predictors of the desire/decision to quit smoking. Analyses were performed separately for 2003 and 2008. A total of 3,229 subjects were included in the survey. There is a significant trend of a decreasing number of smokers in all age groups in 2008, compared to 2003. Almost half of the smokers included in the study expressed desire to quit smoking. Factors contributing significantly to decision to quit smoking were different in 2003 and 2008, except one. Concern about the harmful effects of tobacco smoking on health was a significant predictor in both models. Very worried respondents were more likely to decide to quit smoking (OR 17.6, 95% CI 9.41 to 33.17 vs. OR 12.54; 95% CI 6.0 to 26.2) than those who were not worried at all.

The authors discuss the frequency of indication for and the results of CT and MRI brain scans in patients hospitalized in Vrapce Psychiatric Hospital. They wanted to contribute to the solving of the dilemma whether neuroradiologic tests should be a part of a routine diagnostic procedure in all psychiatric patients. Retrospectively, on the basis of case histories, the patients were analyzed in the first nine months of 2006. In this period 90 CT brain scans and two MRI brain scans were done, most often in the patients who were treated under the diagnoses of endogeneous psychoses, psychoorganic syndrome (dementia), affective disorders and epilepsy. Most CT findings (59%) and both MRI findings were normal. Abnormal findings were most often described as various forms of brain atrophy. Only one brain tumor was found. Electroencephalographic findings quite more often differed significantly from normal in the patients with abnormal CT findings compared with the patients with normal CT findings. The conclusion is that very small number of positive findings, except the brain atrophy, does not give good reason for routine CT and MRI brain scan in all hospitalized psychiatric patients. Indication must be made selectively on the basis of clinical psychiatric-neurologic evaluation. EEG, with limitations, can be of help in this matter.