27 results on '"Špirić, Željko"'
Search Results
2. Posttraumatic stress disorder and art group therapy: Self-expression of traumatic inner world of war veterans
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Mandić-Gajić Gordana and Špirić Željko
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stress disorders ,post-traumatic ,art therapy ,veterans ,psychotherapy ,group ,drawings ,Medicine (General) ,R5-920 - Abstract
Background/Aim. Art therapy and drawings may serve as alternative means of expression and release from trauma among veterans diagnosed with posttraumatic stress disorder (PTSD). Methods. The retrospective clinical study of drawings of war veterans was performed. A total of 89 war veterans met the Diagnostics and Statistical Manual of Mental Disorders (DSM-IV) PTSD criteria and were consecutively admitted to the Day Hospital during 5 years. Art group therapy as part of integrative treatment was performed once a week. The group was open and heterogeneous. Qualitative analysis of drawings content and group protocols were obtained. The drawings were made by free associations. War related themes were explored and descriptive statistics were applied. Results. The most frequent type of common themes of combat stress presented battle and witnessing wounded and killed combatants. Less frequent were themes of graves, destroyed cities and broken trees. The veterans preferred black and red colors with association to death, blood, wounds and destroyed objects. Conclusion. Drawing could provide a unique, complex, visual illustration of war traumatic experiences and memories of posttraumatic stress disorder veterans. Art group discussion might enhance war veterans’ verbal expression due to group support in safe setting. As adjuvant psychotherapy, art group therapy could enrich awareness and the ability of clinicians to treat hard posttraumatic stress disorder symptoms related to uncovered war trauma.
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- 2016
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3. Experience of the air medical evacuation team of Serbian armed forces in the united nations mission in the Democratic Republic of Congo - deployment stress and psychological adaptation
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Joković Danilo B., Krstić Dragan, Stojanović Zvezdana, and Špirić Željko
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stress, psychological ,adaptation, psychological ,medical missions, official ,Serbia ,Medicine (General) ,R5-920 - Abstract
Background/Aim. Wars of the nineties in former Yugoslavia, Somalia, Rwanda imposed new tasks to the United Nations (UN) forces, such as providing humanitarian aid, protection of civilians, peacekeeping, and in many instances providing armed enforcement of peace. The aim of this study was an observational analysis of Serbian participation in the UNs Mission in the Democratic Republic of Congo with the emphasis on stress and coping techniques. Methods. Serbian contribution in this mission dates back to April 2003 till the present days with a military contingent consisting of six members as a part of Air Medical Evacuation Team. The observed stressogenous factors acted before arrival to the mission area and in the mission area. In this paper we analysed ways to overcome them. Results. The productive ways of overwhelming stress used in this mission were: honesty and openness in interpersonal communications, dedication to work, maintaining discipline and order, strict following of appropriate regime of work, diet, rest and recreation; regular communication with family and organizing and participation in various social, cultural and sports manifestations. Conclusion. This analysis indicates that out of all the observed factors, the most important is appropriate selection of personnel.
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- 2016
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4. Correlation and characteristics of self-rating and clinical rating of depression among alcoholics in the course of early abstinence
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Mandić-Gajić Gordana, Samardžić Radomir, and Špirić Željko
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alcoholism ,depression ,comorbidity ,psychiatric status rating scales ,self-evaluation programs ,Medicine (General) ,R5-920 - Abstract
Background/Aim. Depression is an alcoholism relapse risk factor, but frequently stays underdiagnosed among treated alcoholics. The correlation and characteristics of self-reported and clinically assessed depression in the course of early alcohol abstinence were explored. Methods. A total of 100 inpatient, primary male alcoholics (20-60 years) diagnosed according to Classificaton of Mental and Behavioural Disorders (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were recruited consecutively. The Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) were scored on admission (T1), after 4 weeks (T2) and after 8 weeks (T3). Student's t-test, repeated measures ANOVA and Pearson's correlation between the scores were done (p < 0.05). Factor analyses of symptoms were performed. Results: On HDRS T1, T2, T3 90,7%, 39.5%, 17.4% alcoholics were depressive, respectively. The mean HDRS vs BDI scores on T1, T2 and T3 were 15.16 ± 6.34, 7.35 ± 4.18, 4.23 ± 2.93 vs 14.20 ± 9.56, 8.14 ± 7.35, 5.30 ± 4.94, respectively. Depression severity significantly lowered in the course of abstinence (ANOVA). The HRDS and BDI correlations on T1, T2 and T3 were significant (r1 = 0.763, r2 = 0.684, r3 = 0.613 respectively). Dysphoric mood, anxious, vegetative and cognitive HDRS subscales on T1, T2 and T3 were detected, but not BDI factors, thus BDI symptoms were analysed. Conclusions. The majority of alcoholics had depression on admission. A predominant mild-degree with a significant lowering of depression severity and positive significant correlations between HRDS and BDI scores in the course of abstinence were detected. The dysphoric mood on the HDRS sub-scale, and self-blame, anhedonia and guilt BDI symptoms were most prominent and persisted. The BDI could be a useful tool not only for routine screening and reassessment of depression, but also for exploring emotional content during early abstinence and planning tailored integrative therapy and relapse prevention for alcoholics.
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- 2015
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5. Mineralocorticoid receptor and heat shock protein expression levels in peripheral lymphocytes from war trauma-exposed men with and without PTSD
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Matić, Gordana, Milutinović, Danijela Vojnović, Nestorov, Jelena, Elaković, Ivana, Jovanović, Sanja Manitašević, Elzaedi, Younis Mouftah, Perišić, Tatjana, Dunđerski, Jadranka, Damjanović, Svetozar, Knežević, Goran, Špirić, Željko, Vermetten, Eric, and Savić, Danka
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- 2014
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6. Acute psychosis followed by fever: Malignant neuroleptic syndrome or viral encephalitis?
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Stojanović Zvezdana and Špirić Željko
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neuroleptic malignant syndrome ,encephalitis, viral ,diagnosis ,diagnosis, differential ,treatment outcome ,Medicine (General) ,R5-920 - Abstract
Introduction. Neuroleptic malignant syndrome is rare, but potentially fatal idiosyncratic reaction to antipsychotic medications. It is sometimes difficult to diagnose some clinical cases as neuroleptic malignant syndrome and differentiate it from the acute viral encephalitis. Case report. We reported a patient diagnosed with acute psychotic reaction which appeared for the first time. The treatment started with typical antipsychotic, which led to febrility. The clinical presentation of the patient was characterised by the signs and symptoms that might have indicated the neuroleptic malignant syndrome as well as central nervous system viral disease. In order to make a detailed diagnosis additional procedures were performed: electroencephalogram, magnetic resonance imaging of the head, lumbar puncture and a serological test of the cerebrospinal fluid. Considering that after the tests viral encephalitis was ruled out and the diagnosis of neuroleptic malignant syndrome made, antipsychotic therapy was immediately stopped. The patient was initially treated with symptomatic therapy and after that with atypical antipsychotic and electroconvulsive therapy, which led to complete recovery. Conclusion. We present the difficulties of early diagnosis at the first episode of acute psychotic disorder associated with acute febrile condition. Concerning the differential diagnosis it is necessary to consider both neuroleptic malignant syndrome and viral encephalitis, i.e. it is necessary to make the neuroradiological diagnosis and conduct cerebrospinal fluid analysis and blood test. In neuroleptic malignant syndrome treatment a combined use of electroconvulsive therapy and low doses of atypical antipsychotic are confirmed to be successful.
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- 2014
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7. Medical students` health-related quality of life - a comparative study
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Latas Milan, Stojković Tihomir, Ralić Tijana, Jovanović Svetlana, Špirić Željko, and Milovanović Srđan
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quality of life ,students, medical ,students ,Serbia ,health ,psychiatric status rating scales ,questionnaires ,Medicine (General) ,R5-920 - Abstract
Background/Aim. Previous studies on medical students’ subjective perception of health and health-related quality of life (HRQoL) showed inconclusive results. Moreover, there are no published studies to compare HRQoL of medical students to non-medical university students. The aim of the study was to assess subjective perception of health-related quality of life (HRQoL) in medical students’ sample, to compare it with non-medical university stu-dents and to ascertain predictors of better perception of HRQoL in medical students. Methods. Scores of all domains on the Mental and Physical Component Summary subscales and total score of the Short Form Health Survey (SF-36), used for assessment of HRQoL in samples of 561 medical and 332 non-medical university students were assessed and compared. In addition, linear regression to identify predictors of better perception of mental and physical components of HRQoL and overall HRQoL in the sample of medical students was used. The dependant variables were subscores and total score with the SF- 36, and independent variables were certain sociodemographic and academic characteristics of the students. Results. Medical students had statistically significantly higher scores on the Mental Component Summary and total SF-36 score compared to non-medical students. Linear regression analysis demonstrated that higher scores of Physical Component Summary were associated with age, male sex and the year of studies. The Mental Component Summary were associated with age, male sex, the year of studies and marital status. The total SF-36 score was associated with age, male sex and the year of studies. Conclusion. Medical students perceive their health much better than other university students do, but female, older and second grade medical students have worse perception of their HRQoL. Those points should be potential target areas for specific prevention and treatment in order to achieve better HRQoL.
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- 2014
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8. Atypical case of Wilson's disease with psychotic onset, low 24 hour urine copper and the absence of Kayser-Fleischer rings
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Krstić Dragan, Antonijević Jadranka, and Špirić Željko
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hepatolenticular degeneration ,diagnosis ,mental disorders ,copper ,molecular biology ,genetic diseases ,inborn ,treatment outcome ,Medicine (General) ,R5-920 - Abstract
Introduction. Wilson's disease is typically manifested in two clinical forms, neurological and hepatic and in rare cases it starts with psychiatric symptoms exclusively. We presented a rare atypical case of Wilson's disease with psychotic onset. Case report. A 22-year-old male patient was initially presented with predominant signs and symptoms of psychiatric disorder and then later with the development of neurological signs and symptoms. Neuroimaging, detected metal deposits in central nervous system (CNS) but not in peripheral organs, while serum analysis excluded pantothenate-kinase associated neurodegeneration (PKAN) and aceruloplasminemia. In favor of the diagnosis of Wilson's disease there were reduced concentrations of copper and ceruloplasmin concentrations and metal deposits in CNS, but other pathognomonic signs and symptoms were absent: in-creased copper in urine, Kayser-Fleischer rings in Descemet’s corneal membrane and deposits of copper in liver. Introduction of penicillamine treatment resulted in improvement in mental and general health of the patient. Molecular genetic analysis definitely confirmed the diagnosis of Wilson's disease. Conclusion. Wilson's disease can remain undetected for a long period of time if masked with dominant or exclusive psychiatric symptoms. If clear clinical symptoms and signs, and unambiguous laboratory findings are not present, it is necessary to perform molecular genetic analysis to confirm the definitive diagnosis.
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- 2014
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9. Lymphocyte glucocorticoid receptor expression level and hormone-binding properties differ between war trauma-exposed men with and without PTSD
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Matić, Gordana, Milutinović, Danijela Vojnović, Nestorov, Jelena, Elaković, Ivana, Jovanović, Sanja Manitašević, Perišić, Tatjana, Dunđerski, Jadranka, Damjanović, Svetozar, Knežević, Goran, Špirić, Željko, Vermetten, Eric, and Savić, Danka
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- 2013
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10. Is there a biological difference between trauma-related depression and PTSD? DST says ‘NO’
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Savic, Danka, Knezevic, Goran, Damjanovic, Svetozar, Spiric, Zeljko, and Matic, Gordana
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- 2012
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11. The role of personality and traumatic events in cortisol levels – Where does PTSD fit in?
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Savic, Danka, Knezevic, Goran, Damjanovic, Svetozar, Spiric, Zeljko, and Matic, Gordana
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- 2012
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12. Pharmacological treatment of stress-induced hypertension: Guidelines and dilemmas
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Matunović Radomir, Samardžić Janko, Špirić Željko, Marinković Dejan, Gudelj Ognjen, Obradović Dragan, Mijailović Zdravko, and Rafajlovski Sašo
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hypertension ,stress, psychological ,comorbidity ,drug therapy ,Medicine (General) ,R5-920 - Abstract
nema
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- 2011
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13. Gender differences in victims of war torture: Types of torture and psychological consequences
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Špirić Željko, Opačić Goran, Jović Vladimir, Samardžić Radomir, Knežević Goran, Mandić-Gajić Gordana, and Todorović Milorad
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war ,torture ,gender identity ,stress disorders ,posttraumatic ,psychological tests ,psychopathology ,Medicine (General) ,R5-920 - Abstract
Background/Aim. Torture for political reasons is an extreme violence in interpersonal relations resulting in not only acute psychiatric disorders but also very often in very severe and far reaching negative consequences for the overall psychosocial functioning of a victim. The aim of this study was to investigate gender differences in types of torture and psychological consequences in subjects who experienced war torture. Methods. A sample (410 men and 76 women) included clients of 'Centre for rehabilitation of torture victims - IAN, Belgrade' who experienced torture in prisons and concentration camps during civil wars in ex-Yugoslavia 1991-1995 and 1999. Types of Torture Questionnaire with 81 items was used for collecting data about forms of torture. Symptom Checklist 90-Revised (SCL-90- R) was used for assessing type and intensity of psychological symptoms, and Impact of Event Scale (IES) was used to estimate posttraumatic complaints. Results. A gender difference was found for 33 types of torture: 28 more frequent in men, and 5 in women. Factor analysis of torture types revealed three factors explaining 29% of variance: 'common torture', 'sadistic torture', and 'sexual torture'. Discriminant analysis revealed significant gender difference concerning the factors. 'Common torture' and 'sadistic torture' were more prominent in men, and 'sexual torture' was more present in women. Higher scores on depression, anxiety, somatization, interpersonal sensitivity and obsessive-compulsive dimensions on SCL-90-R were found in women. General score and scores of subscales (intrusion and avoidance) on IES were significantly higher in women. Conclusion. Women exposed to war torture experienced less torture techniques and shorter imprisonment than men, but had more frequent and severe symptoms of posttraumatic stress disorder and other psychological symptoms. Gender differences in posttraumatic symptomatology can not be explained exclusively by gender differences in types of torture found in this study.
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- 2010
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14. Excessive internet use: Addiction disorder or not?
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Hinić Darko, Mihajlović Goran, Špirić Željko, Đukić-Dejanović Slavica, and Jovanović Mirjana
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mental disorders ,habits ,internet ,Medicine (General) ,R5-920 - Published
- 2008
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15. Comorbidity of posttraumatic stress disorder and mild closed head injury in war veterans: Endocrinological and psychological profiles
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Špirić Željko and Samardžić Radomir
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stress disorders ,post-traumatic ,head injuries ,closed ,psychological tests ,hormones ,amnesia ,veterans ,Yugoslavia ,Medicine (General) ,R5-920 - Abstract
Aim. To determine the degree of psychological and endocrinological changes in war veterans with the diagnosis of Chronic Posttraumatic Stress Disorder (PTSD) regarding presence/absence of comorbid mild closed head injury (mCHI) caused by explosive devices. Methods. Two groups of PTSD inpatients, with (n = 37), and without (n = 86) sustained blast trauma followed by mCHI were formed during the psychiatric treatment. Participants were interviewed by experienced clinicians who used the PTSD Interview (PTSD-I). In addition, patients completed the Symptom Checklist-90-Revised (SCL-90-R). Serum levels of ten hormones were assessed: triiodothyronine, thyroxine, thyrotropin-stimulating hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and insulin, by radioimmunoassays and hydrocortisone, growth hormone and testosterone by fluoroimmunoassays. Results. Veterans with comorbid mCHI and PTSD showed significantly higher level of amnesia for traumatic event as well as of somatization on the SCL-90-R. Significant differences of hormone levels were not found. Conclusion. The results didn't support the hypothesis on specific PTSD subgroup characterized by history of mCHI and consecutive postconcussion syndrome. The absence of differences in levels of hormones indicated the dominant role of psychogenic trauma in the etiology of hormone disbalance in chronic PTSD. Amnesia for traumatic event in war veterans with comorbid PTSD and mCHI was easily explained by neurogenic peritraumatic amnesia due to the blast trauma, but it did not affect either quality of intensity or posttraumatic symptoms as well as endocrinological parameters.
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- 2005
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16. Predictive factors of psychosomatic reactions during air raids
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Samardžić Radomir and Špirić Željko
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stress ,psychological ,psychophysiologic disorders ,personality disorders ,war ,explosions ,Yugoslavia ,Medicine (General) ,R5-920 - Abstract
Background. Civilian population of Yugoslavia was exposed to massive stressors of air raids by NATO in 1999. The aim of this study was to investigate somatic complaints and their predictive factors during stresses of air raids. Methods. Random sample of 434 subjects, consisting of 139 inhabitants of several Belgrade municipalities and 295 employees of Military Medical Academy, were assessed in the cross-sectional study. The basic factors of interest were stress severity, variables of personality and habits and behavior relevant for somatic complaints. Self-report of stress severity and the most common somatic complaints were performed by Questionnaire specially designed for this purpose and personality evaluation by EPQ-38. Multiple regression analysis was used to determine the influence of predictors on dependent variable (psychosomatic symptoms). Results. Personality was the most important predictor that explained 29% of variance in somatic symptoms (with the strongest impact of neuroticism); 11% was explained by habits and behavior and only 1% of variance by stress. Conclusion. The finding that personality had higher impact on stress reaction outcome could be important for preventive and therapeutic aspects of stress reactions.
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- 2005
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17. Posttraumatski stresni poremećaj
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Samardžić Radomir and Špirić Željko
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stress disorders ,post-traumatic ,psychotherapy ,drug therapy ,Medicine (General) ,R5-920 - Published
- 2004
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18. Analiza kognicije i razvojnog prilagođavanja kod osoba pod različitim rizikom za psihozu
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Marić-Bojović, Nađa, Knežević, Goran, Jovanović, Aleksandar, Špirić, Željko, Batinić, Borjanka, Andrić-Petrović, Sanja V., Marić-Bojović, Nađa, Knežević, Goran, Jovanović, Aleksandar, Špirić, Željko, Batinić, Borjanka, and Andrić-Petrović, Sanja V.
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Psihotični poremećaji predstavljaju heterogene kliničke sindrome u čijoj etiopatogenezi ključno mesto imaju interakcija gena i uticaja poreklom iz spoljašnje sredine. Prema neurorazvojnoj teoriji, ova grupa poremećaja se smatra kasnom manifestacijom oštećenog neurorazvoja. Usled postepenog zastoja u usklađivanju funkcija određenih regiona mozga, osobe koje će tek u ranom odraslom dobu ispuniti kriterijume za dijagnozu već tokom perioda odrastanja imaju suptilne izmene u ponašanju, neuromotornim i saznajnim funkcijama. Poremećaj saznajnih funkcija - kognicije (neurokognicije i socijalne kognicije) nastaje kao posledica suptilnih oštećenja tokom neurorazvoja. Ovo jezgrovno obeležje psihotičnih poremećaja je relativno uočljivo u premorbidnom periodu, kada se ispoljava kao diskretna maladaptacija u detinjstvu i u ranoj adolescenciji. Nakon pojave kliničke forme bolesti, poremećaj kognicije je upadljiv i zbog svojih karakteristika (visoka učestalost, postojanost u svim fazama bolesti) deficiti neurokognicije i socijalne kognicije su prepoznati kao potencijalni kandidati za prelazne fenotipove. Ispitivanje prelaznih fenotipova može se vršiti analizom osoba sa različitim jačinama rizika za psihozu, na primer prvostepenih srodnika obolelih koji u većoj meri dele nepovoljne nasledne i sredinske faktore nego što je to slučaj sa opštom populacijom. Međutim, nalazi dosadašnjih studija koje su ispitivale kognitivne i adaptivne kapacitete zdravih prvostepenih srodnika psihotičnih pacijenata relativno su retki i nekonzistentni, zbog čega postoji potreba za daljim izučavanjem navedenih fenotipova kod osoba pod različitim naslednim rizikom za psihozu. Primenom genetski senzitivnog dizajna u aktuelnom istraživanju su ispitivane razlike u kognitivnim sposobnostima (IQ, sposobnost prepoznavanja emocija) i uspešnosti razvojne adaptacije kod osoba pod različitim rizikom za psihozu (pacijenata, njihovih zdravih prvostepenih srodnika i kontrola), kao i grupisanje i ukrštena kovarijacija na
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- 2017
19. Ispitivanje efekta elektrokonvulzivne terapije na kognitivne i mnestičke funkcije kod osoba sa depresijom
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Marić-Bojović, Nađa, Đukić-Dejanović, Slavica, Mihajlović, Goran, Špirić, Željko, Stojanović, Zvezdana B., Marić-Bojović, Nađa, Đukić-Dejanović, Slavica, Mihajlović, Goran, Špirić, Željko, and Stojanović, Zvezdana B.
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Cilj ove studije bio je da se utvrdi anterogradni efekat elektrokonvulzivne terapije (EKT) na kognitivne i mnestičke funkcije upotrebom odabranih testova iz Cambridge Neuropsychological Test Automated Battery (CANTAB), kod osoba sa depresijom (major depresivni poremećaj – MDP). Ispitanici su hospitalno lečeni u Klinici za psihijatriju Vojnomedicinske akademije. EKT je bio indikovan jer su prethodno ovi ispitanici imali nezadovoljavajući terapijski odgovor na najmanje dva različita antidepresiva (ispunjavaju kriterijume terapijske rezistencije). Ukupno 30 osoba sa dijagnozom MDP, tretirano je EKT uporedo sa njihovom prethodnom medikamentoznom terapijom. Procene afektivnog statusa vršene su instrumentima kliničke procene: Hamiltonova skala za procenu depresivnosti (HAMD), Skala depresivnosti, anksioznosti i stresa (DASS-42) i Skala opšteg kliničkog utiska (CGI), dok je za opšte ispitivanje kognitivnog statusa korišćena Mala skala procene mentalnog stanja (MMSE). Za precizniju procenu pojedinih aspekata kognitivnog statusa - memorije i egzekutivnih funkcija, rađeni su neuropsihološki testovi: Odloženo sparivanje prema uzorku - Delayed matching to sample (DMS), Učenje parova - Paired associates learning (PAL), Prostorna rekognicija - Spatial recognition memory (SRM), Figuralna rekognicija - Pattern recognition memory (PRM) i Test planiranja i radne memorije - One Touch Stockings of Cambridge (SOC). Isptivanja su rađena prospektivno, u tri etape: pre početka primene EKT (T0), neposredno po završetku serije EKT (T1) i mesec dana nakon EKT (T2). Rezultati su diskutovani u svetlu različitih podataka u vezi efikasnosti EKT u lečenju major depresije, kao i u vezi efekta EKT na kognivne i mnestičke funkcije. Rezultati istraživanja su sadržani u sledećim zaključcima: 1. Elektorkonvulzivna terapija je efikasan tretman za lečenje major depresivnog poremećaja. 2. Tokom lečenja elektrokonvulzivnom terapijom nisu zabležena pogoršanja u kognitivnim i mnestičkim funkcijama. 3. Deficit, The aim of this study was to evaluate the anterograde effect of bitemporal electroconvulsive therapy (ECT) on cognitive and mnestic functions using tests selected from the Cambridge Neuropsychological Test Automated Battery (CANTAB), in persons with major depressive disorder - MDD. The patients were hospitalized at the Department of Psychiatry, Military Medical Academy, after unsatisfactory responses to at least two different antidepressants (they fulfilled the criteria for treatment resistance), thus the indication for ECT was met. Thirty patients diagnosed with treatment resistant major depression, were treated with ECT, in paralel with psychopharmacotherapy based on the doctors’ choice. Clinical evaluation was done using the following rating scales: Hamilton Depression Rating Scale (HAMD), Depression Anxiety Stress Scale (DASS-42), Clinical global impression scale (CGI), and Mini-Mental State Examination (MMSE) for general examination of the cognitive status. To assess specific aspects of the cognitive status i.e. memory and executive functions, following neuropsychological tests were used: Delayed matching to sample (DMS), Paired associate learning (PAL), Spatial recognition memory (SRM), Pattern recognition memory (PRM), One Touch Stockings of Cambridge (SOC). The assesment was performed before ECT (T0), immediately after a course of ECT (T1) and a month after ECT (T2). The results are discussed in the light of various data on the efficacy of ECT in treatment major depression, and about the effect ЕCT on the cognitive and mnestic functions. The research results are contained in the following conclusions: 1. ECT showed strong antidepressant effect in patients with MDD 2. During the treatment, electroconvulsive therapy was not observed deterioration in the performance on any cognitive test 3. It has been shown that cognitive deficits associated with the acute phase of depression, improve during the recovery from depression treated with ECT, particularly in a fiel
- Published
- 2016
20. Kvalitet života povezan sa zdravstvenim stanjem studenata medicine - komparativna studija
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Latas, Milan, Stojković, Tihomir, Ralić, Tijana, Jovanović, Svetlana, Špirić, Željko, and Milovanović, Srđan
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students ,studenti medicine ,education ,psychiatric status rating scales ,upitnici ,Srbija ,health ,questionnaires ,određivanje ,medical ,skale ,kvalitet života ,quality of life ,studenti ,zdravlje ,psihijatrijski status ,Serbia - Abstract
Background/Aim. Previous studies on medical students' subjective perception of health and health-related quality of life (HRQoL) showed inconclusive results. Moreover, there are no published studies to compare HRQoL of medical students to non-medical university students. The aim of the study was to assess subjective perception of health-related quality of life (HRQoL) in medical students' sample, to compare it with non-medical university stu-dents and to ascertain predictors of better perception of HRQoL in medical students. Methods. Scores of all domains on the Mental and Physical Component Summary subscales and total score of the Short Form Health Survey (SF-36), used for assessment of HRQoL in samples of 561 medical and 332 non-medical university students were assessed and compared. In addition, linear regression to identify predictors of better perception of mental and physical components of HRQoL and overall HRQoL in the sample of medical students was used. The dependant variables were subscores and total score with the SF- 36, and independent variables were certain sociodemographic and academic characteristics of the students. Results. Medical students had statistically significantly higher scores on the Mental Component Summary and total SF-36 score compared to non-medical students. Linear regression analysis demonstrated that higher scores of Physical Component Summary were associated with age, male sex and the year of studies. The Mental Component Summary were associated with age, male sex, the year of studies and marital status. The total SF-36 score was associated with age, male sex and the year of studies. Conclusion. Medical students perceive their health much better than other university students do, but female, older and second grade medical students have worse perception of their HRQoL. Those points should be potential target areas for specific prevention and treatment in order to achieve better HRQoL., Uvod/Cilj. Dosadašnje studije subjektivne percepcije zdravlja i kvaliteta života povezanog sa zdravstvenim stanjem (HRQoL) studenata medicine pokazale su kontradiktorne rezultate. Štaviše, ne postoje objavljene studije koje su poredile HRQoL studenata medicine i studenata ne- medicinskih fakulteta. Cilj ove studije bio je da se proceni subjektivna percepcija HRQoL na uzorku studenata medicine, da se uporedi sa percepcijom HRQoL studenata ne- medicinskih fakulteta i da se utvrde prediktori bolje percepcije HRQoL kod studenata medicine. Metode. Uzorak za istraživanje obuhvatio je 561 studenta medicine i 332 studenta ne-medicinskih fakulteta Univerziteta u Beogradu. Istraživanje je obavljeno uz pomoć Short Form Health Survey (SF-36) upitnika koji procenjuje mentalnu i fizičku komponentu, kao i ukupan skor subjektivne procene kvaliteta života vezanog za zdravstveno stanje. Upoređeni su skorovi sa zbirne skale i supskala dve grupe studenata. Pored toga, korišćena je i linearna regresija da bi se procenili prediktori boljeg sagledavanja ukupnog skora i mentalne i fizičke komponente HRQoL na uzorku studenata medicine. Zavisne varijable bile su supskorovi i ukupan skor sa SF- 36 upitnika, a nezavisne varijable sociodemografske i akademske karakteristike ispitanika. Rezultati. Studenti medicine imali su statistički značajno više skorove na supskali mentalnog zdravlja i na ukupnom skoru SF-36 upitnika u odnosu na studente ne-medicinskih fakulteta. Linearna regresija pokazala je da su viši skorovi fizičke komponente povezani sa godinama starosti, muškim polom i godinom studija; viši skorovi mentalne komponente povezani sa godinama starosti, muškim polom, godinom studija i bračnim statusom. Ukupan SF-36 skor povezan je sa godinama starosti, muškim polom i godinom studija. Zaključak. Studenti medicine gledaju na svoje zdravstveno stanje mnogo bolje nego studenti ne-medicinskih fakulteta. Ipak, devojke, stariji studenti i studenti druge godine medicine imaju lošiju percepciju svog kvaliteta života koji se vezuje za zdravlje. Ovo bi trebalo da budu fokusi za specifičnu prevenciju i eventualnu terapiju u cilju postizanja boljeg kvaliteta života studenata medicine.
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- 2014
21. Medical students' health-related quality of life: A comparative study
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Latas, Milan, Latas, Milan, Stojković, Tihomir, Ralić, Tijana, Jovanović, Svetlana, Špirić, Željko, Milovanović, Srđan, Latas, Milan, Latas, Milan, Stojković, Tihomir, Ralić, Tijana, Jovanović, Svetlana, Špirić, Željko, and Milovanović, Srđan
- Abstract
Background/Aim. Previous studies on medical students' subjective perception of health and health-related quality of life (HRQoL) showed inconclusive results. Moreover, there are no published studies to compare HRQoL of medical students to non-medical university students. The aim of the study was to assess subjective perception of health-related quality of life (HRQoL) in medical students' sample, to compare it with non-medical university stu-dents and to ascertain predictors of better perception of HRQoL in medical students. Methods. Scores of all domains on the Mental and Physical Component Summary subscales and total score of the Short Form Health Survey (SF-36), used for assessment of HRQoL in samples of 561 medical and 332 non-medical university students were assessed and compared. In addition, linear regression to identify predictors of better perception of mental and physical components of HRQoL and overall HRQoL in the sample of medical students was used. The dependant variables were subscores and total score with the SF- 36, and independent variables were certain sociodemographic and academic characteristics of the students. Results. Medical students had statistically significantly higher scores on the Mental Component Summary and total SF-36 score compared to non-medical students. Linear regression analysis demonstrated that higher scores of Physical Component Summary were associated with age, male sex and the year of studies. The Mental Component Summary were associated with age, male sex, the year of studies and marital status. The total SF-36 score was associated with age, male sex and the year of studies. Conclusion. Medical students perceive their health much better than other university students do, but female, older and second grade medical students have worse perception of their HRQoL. Those points should be potential target areas for specific prevention and treatment in order to achieve better HRQoL., Uvod/Cilj. Dosadašnje studije subjektivne percepcije zdravlja i kvaliteta života povezanog sa zdravstvenim stanjem (HRQoL) studenata medicine pokazale su kontradiktorne rezultate. Štaviše, ne postoje objavljene studije koje su poredile HRQoL studenata medicine i studenata ne- medicinskih fakulteta. Cilj ove studije bio je da se proceni subjektivna percepcija HRQoL na uzorku studenata medicine, da se uporedi sa percepcijom HRQoL studenata ne- medicinskih fakulteta i da se utvrde prediktori bolje percepcije HRQoL kod studenata medicine. Metode. Uzorak za istraživanje obuhvatio je 561 studenta medicine i 332 studenta ne-medicinskih fakulteta Univerziteta u Beogradu. Istraživanje je obavljeno uz pomoć Short Form Health Survey (SF-36) upitnika koji procenjuje mentalnu i fizičku komponentu, kao i ukupan skor subjektivne procene kvaliteta života vezanog za zdravstveno stanje. Upoređeni su skorovi sa zbirne skale i supskala dve grupe studenata. Pored toga, korišćena je i linearna regresija da bi se procenili prediktori boljeg sagledavanja ukupnog skora i mentalne i fizičke komponente HRQoL na uzorku studenata medicine. Zavisne varijable bile su supskorovi i ukupan skor sa SF- 36 upitnika, a nezavisne varijable sociodemografske i akademske karakteristike ispitanika. Rezultati. Studenti medicine imali su statistički značajno više skorove na supskali mentalnog zdravlja i na ukupnom skoru SF-36 upitnika u odnosu na studente ne-medicinskih fakulteta. Linearna regresija pokazala je da su viši skorovi fizičke komponente povezani sa godinama starosti, muškim polom i godinom studija; viši skorovi mentalne komponente povezani sa godinama starosti, muškim polom, godinom studija i bračnim statusom. Ukupan SF-36 skor povezan je sa godinama starosti, muškim polom i godinom studija. Zaključak. Studenti medicine gledaju na svoje zdravstveno stanje mnogo bolje nego studenti ne-medicinskih fakulteta. Ipak, devojke, stariji studenti i studenti druge godine medicine imaju lošiju percepciju svo
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- 2014
22. Efekti kombinovane transkranijalne magnetne stimulacije i deprivacije spavanja u tretmanu major depresija
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Ilić, Tihomir V., Nedeljković, Nadežda, Špirić, Željko, Krstić, Jelena D., Ilić, Tihomir V., Nedeljković, Nadežda, Špirić, Željko, and Krstić, Jelena D.
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Cilj rada. Cilj ovog rada je procena efekata kombinovane primene repetitivne transkranijalne magnetne stimulacije (rTMS) niske frekvencije (1 Hz) i parcijalne deprivacije spavanja (PDS) kod osoba obolelih od major depresije, koje prethodno pokazuju nezadovoljavajući odgovor na dva različita antidepresiva (ispunjavaju kriterijume terapijske rezistencije). Uporedo sa dugoročnim praćenjem (do 6 meseci) efekata ovog tretmana, analiziran je i genetički BDNF Val66Met polimorfizam, kao mogući perimisivni faktor plasticiteta odgovoran za predikciju efikasnosti primenjenih terapijskih strategija. Ispitanici i metode. Ukupno 20 osoba obolelih od major depresije, koje su ispunjavale kriterijume terapijske rezistencije tretirano je na navedeni način kombinacijom rTMS i PDS, uporedo sa njihovom prethodnom medikamentoznom terapijom. Kombinovani protokol rTMS i PDS sprovodio se tokom dve uzastopne nedelje, i za to vreme su ispitanici svakog dana, izuzev pauze za vikend dobijali stimulaciju rTMS (frekvencija 1 Hz, intenzitet 110% praga izazivanja motornog odgovora) primenjivanu iznad desnog dorzolateralnog prefrontalnog korteksa (DLPFK), u jutarnjim časovima. U svakoj nedelji po jednom, opisanoj rTMS, prethodila je redukcija noćnog spavanja uz buđenje u pola 2. Ispitanici su randomski podeljeni u grupu koja je primala rTMS+PDS i grupu koja je primala placebo (sham) rTMS stimulaciju + PDS. Procene efekta vršene su standardnim instrumentima kliničke procene (modifikovana Hamiltonova skala za procenu depresivnosti - HDRS-24; Montgomery-Asberg skala za procenu depresivnosti - MADRS, i skala opšteg kliničkog utiska), i to: pre početka primene protokola, neposredno po završetku, jednu nedelju kasnije, tri i šest meseci kasnije (dugoročna praćenja sprovedena su isključivo kod ispitanika koji su bili podvrgnuti aktivnom tretmanu). Rezultati. Primenjeni protokol stimulacije pokazao je antidepresivni efekat, kod osoba obolelih od unipolarne depresije na nepromenjenoj dozi antidepresivnih lek, Objectives. The main aim of this study was to evaluate potential synergistic antidepressant effect of two therapies: repetitive transcranial magnetic stimulation (rTMS) applied at 1 Hz associated with partial sleep deprivation (PSD) in patients with treatment resistant major depression. Besides the long- term (during the next 6 months) evaluation of effecacy of this treatment, potential predictive role of brain-derived neurotrophic factor (BDNF) Val66Met genetic polymorphism in rTMS treatment response was analysed, as a factor of neuronal plasticity, also involved in patogenesis of major depression Subjects and methods Twenty patients with diagnoses of treatment resistant major depression, at fixed doses of antidepressants, were treated with combination of rTMS and PSD. rTMS was applied during two consecutive weeks (5 days/week) with frequency of 1Hz, at 110% intensity of resting motor threshold, over the right dorso-lateral prefrontal cortex (DLPFC), in the morrning hours. Partial sleep deprivation was applied once during every week, as late partial sleep deprivation (patients were woke up at 01.30 a.m.). Patients were randomly assigned to receive rTMS+PSD, or sham+PSD. Clinical evaluation was done using the following rating scales: the modified Hamilton depression rating scale (HDRS-24), Montgomery-Asberg rating scale (MADRS ) and Clinical global impression scale (CGI-S), at baseline, after 2 weeks of treatment and one week after treatment, as well as long-term follow-up (only patients treated with active rTMS). Results. Study results suggest clinically relevant response, lasted up to 6 months in patients with unipolar major depression at fixed doses of antidepressants. After 2 weeks of treatment, patients treated with active rTMS had the average improvement of 39% score reduction on HDRS...
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- 2012
23. Polne razlike kod žrtava ratne torture s obzirom na vrste mucenja i psihološke posledice.
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Špirić, Željko, Opačić, Goran, Jović, Vladimir, Samardžić, Radomir, Knežević, Goran, Mandić-Gajić, Gordana, and Todorović, Milorad
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TORTURE , *PSYCHOSOCIAL factors , *TORTURE victims , *POST-traumatic stress disorder , *WAR crimes , *PATHOLOGICAL psychology , *PSYCHOLOGY - Abstract
Background/Aim. Torture for political reasons is an extreme violence in interpersonal relations resulting in not only acute psychiatric disorders but also very often in very severe and far reaching negative consequences for the overall psychosocial functioning of a victim. The aim of this study was to investigate gender differences in types of torture and psychological consequences in subjects who experienced war torture. Methods. A sample (410 men and 76 women) included clients of "Centre for rehabilitation of torture victims - IAN, Belgrade" who experienced torture in prisons and concentration camps during civil wars in ex- Yugoslavia 1991-1995 and 1999. Types of Torture Questionnaire with 81 items was used for collecting data about forms of torture. Symptom Checklist 90-Revised (SCL-90- R) was used for assessing type and intensity of psychological symptoms, and Impact of Event Scale (IES) was used to estimate posttraumatic complaints. Results. A gender difference was found for 33 types of torture: 28 more frequent in men, and 5 in women. Factor analysis of torture types revealed three factors explaining 29% of variance: "common torture", "sadistic torture", and "sexual torture". Discriminant analysis revealed significant gender difference concerning the factors. "Common torture" and "sadistic torture" were more prominent in men, and "sexual torture" was more present in women. Higher scores on depression, anxiety, somatization, interpersonal sensitivity and obsessive- compulsive dimensions on SCL-90-R were found in women. General score and scores of subscales (intrusion and avoidance) on IES were significantly higher in women. Conclusion. Women exposed to war torture experienced less torture techniques and shorter inprisonment than men, but had more frequent and severe symptoms of posttraumatic stress disorder and other psychological symptoms. Gender differences in posttraumatic symptomatology can not be explained exclusively by gender differences in types of torture found in this study. [ABSTRACT FROM AUTHOR]
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- 2010
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24. Farmakološko lečenje hipertenzije indukovane stresom -- preporuke i dileme.
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Matunović, Radomir, Samardžić, Janko, Špirić, Željko, Marinković, Dejan, Gudelj, Ognjen, Obradović, Dragan, Mijailović, Zdravko, and Rafajlovski, Sašo
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HYPERTENSION , *PSYCHOLOGICAL stress , *PHARMACOLOGY , *CARDIOVASCULAR diseases , *MORTALITY , *MYOCARDIAL infarction , *ETIOLOGY of diseases - Published
- 2011
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25. Cognition and developmental adjustment among individuals at different risk of psychotic disorders
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Andrić-Petrović, Sanja V., Marić-Bojović, Nađa, Knežević, Goran, Jovanović, Aleksandar, Špirić, Željko, and Batinić, Borjanka
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cognition ,srodnici pacijenata ,developmental adjustment ,intermediate phenotype ,prognostic factors ,prelazni fenotip ,prognostički faktori ,razvojna adaptacija ,kognicija ,psihotični poremećaji ,patients’ siblings ,IQ ,psychotic disorders ,emotion recognition ,prepoznavanje emocija - Abstract
Psihotični poremećaji predstavljaju heterogene kliničke sindrome u čijoj etiopatogenezi ključno mesto imaju interakcija gena i uticaja poreklom iz spoljašnje sredine. Prema neurorazvojnoj teoriji, ova grupa poremećaja se smatra kasnom manifestacijom oštećenog neurorazvoja. Usled postepenog zastoja u usklađivanju funkcija određenih regiona mozga, osobe koje će tek u ranom odraslom dobu ispuniti kriterijume za dijagnozu već tokom perioda odrastanja imaju suptilne izmene u ponašanju, neuromotornim i saznajnim funkcijama. Poremećaj saznajnih funkcija - kognicije (neurokognicije i socijalne kognicije) nastaje kao posledica suptilnih oštećenja tokom neurorazvoja. Ovo jezgrovno obeležje psihotičnih poremećaja je relativno uočljivo u premorbidnom periodu, kada se ispoljava kao diskretna maladaptacija u detinjstvu i u ranoj adolescenciji. Nakon pojave kliničke forme bolesti, poremećaj kognicije je upadljiv i zbog svojih karakteristika (visoka učestalost, postojanost u svim fazama bolesti) deficiti neurokognicije i socijalne kognicije su prepoznati kao potencijalni kandidati za prelazne fenotipove. Ispitivanje prelaznih fenotipova može se vršiti analizom osoba sa različitim jačinama rizika za psihozu, na primer prvostepenih srodnika obolelih koji u većoj meri dele nepovoljne nasledne i sredinske faktore nego što je to slučaj sa opštom populacijom. Međutim, nalazi dosadašnjih studija koje su ispitivale kognitivne i adaptivne kapacitete zdravih prvostepenih srodnika psihotičnih pacijenata relativno su retki i nekonzistentni, zbog čega postoji potreba za daljim izučavanjem navedenih fenotipova kod osoba pod različitim naslednim rizikom za psihozu. Primenom genetski senzitivnog dizajna u aktuelnom istraživanju su ispitivane razlike u kognitivnim sposobnostima (IQ, sposobnost prepoznavanja emocija) i uspešnosti razvojne adaptacije kod osoba pod različitim rizikom za psihozu (pacijenata, njihovih zdravih prvostepenih srodnika i kontrola), kao i grupisanje i ukrštena kovarijacija navedenih svojstava unutar porodica psihotičnih pacijenata (identifikacija prelaznih fenotipova)...
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- 2017
26. Ispitivanje efekta elektrokonvulzivne terapije na kognitivne i mnestičke funkcije kod osoba sa depresijom
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Stojanović, Zvezdana B., Marić-Bojović, Nađa, Đukić-Dejanović, Slavica, Mihajlović, Goran, and Špirić, Željko
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Cilj ove studije bio je da se utvrdi anterogradni efekat elektrokonvulzivne terapije (EKT) na kognitivne i mnestičke funkcije upotrebom odabranih testova iz Cambridge Neuropsychological Test Automated Battery (CANTAB), kod osoba sa depresijom (major depresivni poremećaj – MDP). Ispitanici su hospitalno lečeni u Klinici za psihijatriju Vojnomedicinske akademije. EKT je bio indikovan jer su prethodno ovi ispitanici imali nezadovoljavajući terapijski odgovor na najmanje dva različita antidepresiva (ispunjavaju kriterijume terapijske rezistencije). Ukupno 30 osoba sa dijagnozom MDP, tretirano je EKT uporedo sa njihovom prethodnom medikamentoznom terapijom. Procene afektivnog statusa vršene su instrumentima kliničke procene: Hamiltonova skala za procenu depresivnosti (HAMD), Skala depresivnosti, anksioznosti i stresa (DASS-42) i Skala opšteg kliničkog utiska (CGI), dok je za opšte ispitivanje kognitivnog statusa korišćena Mala skala procene mentalnog stanja (MMSE). Za precizniju procenu pojedinih aspekata kognitivnog statusa - memorije i egzekutivnih funkcija, rađeni su neuropsihološki testovi: Odloženo sparivanje prema uzorku - Delayed matching to sample (DMS), Učenje parova - Paired associates learning (PAL), Prostorna rekognicija - Spatial recognition memory (SRM), Figuralna rekognicija - Pattern recognition memory (PRM) i Test planiranja i radne memorije - One Touch Stockings of Cambridge (SOC). Isptivanja su rađena prospektivno, u tri etape: pre početka primene EKT (T0), neposredno po završetku serije EKT (T1) i mesec dana nakon EKT (T2). Rezultati su diskutovani u svetlu različitih podataka u vezi efikasnosti EKT u lečenju major depresije, kao i u vezi efekta EKT na kognivne i mnestičke funkcije. Rezultati istraživanja su sadržani u sledećim zaključcima: 1. Elektorkonvulzivna terapija je efikasan tretman za lečenje major depresivnog poremećaja. 2. Tokom lečenja elektrokonvulzivnom terapijom nisu zabležena pogoršanja u kognitivnim i mnestičkim funkcijama. 3. Deficit kognitivnih funkcija koji je povezan sa samom bolešću tj. akutnom fazom depresije, poboljšava se tokom oporavka od depresije i lečenja EKT i to u domenu vizuelne memorije i učenja (PAL) i brzini započinjanja rešavanja problema (jedne od egzekutivnih funkcija). Ovo je prva studija u Srbiji kojom su trenutno najpouzdanijim metodama testiranja kognicije praćeni efekti EKT na memoriju i egzekutivne funkcije. Potvrđen je nalaz iz svetske literature i prakse u vezi sa efikasnošću EKT u lečenju MDP. Pored toga pokazano je da se deficit kognitivnih funkcija koji je povezan sa akutnom fazom depresije, poboljšava tokom oporavka od depresije i lečenja EKT i to u domenu vizuelne memorije i učenja (PAL) i brzine započinjanja rešavanja problema (jedne od egzekutivnih funkcija). Aktuelni nalazi daju važne informacije za kliničku praksu tj. za efikasnije i sigurnije lečenja depresivnog poremećaja za sada nedovoljno korišćenom metodom lečenja – elektrokonvulzivnom terapijom. The aim of this study was to evaluate the anterograde effect of bitemporal electroconvulsive therapy (ECT) on cognitive and mnestic functions using tests selected from the Cambridge Neuropsychological Test Automated Battery (CANTAB), in persons with major depressive disorder - MDD. The patients were hospitalized at the Department of Psychiatry, Military Medical Academy, after unsatisfactory responses to at least two different antidepressants (they fulfilled the criteria for treatment resistance), thus the indication for ECT was met. Thirty patients diagnosed with treatment resistant major depression, were treated with ECT, in paralel with psychopharmacotherapy based on the doctors’ choice. Clinical evaluation was done using the following rating scales: Hamilton Depression Rating Scale (HAMD), Depression Anxiety Stress Scale (DASS-42), Clinical global impression scale (CGI), and Mini-Mental State Examination (MMSE) for general examination of the cognitive status. To assess specific aspects of the cognitive status i.e. memory and executive functions, following neuropsychological tests were used: Delayed matching to sample (DMS), Paired associate learning (PAL), Spatial recognition memory (SRM), Pattern recognition memory (PRM), One Touch Stockings of Cambridge (SOC). The assesment was performed before ECT (T0), immediately after a course of ECT (T1) and a month after ECT (T2). The results are discussed in the light of various data on the efficacy of ECT in treatment major depression, and about the effect ЕCT on the cognitive and mnestic functions. The research results are contained in the following conclusions: 1. ECT showed strong antidepressant effect in patients with MDD 2. During the treatment, electroconvulsive therapy was not observed deterioration in the performance on any cognitive test 3. It has been shown that cognitive deficits associated with the acute phase of depression, improve during the recovery from depression treated with ECT, particularly in a field of visual memory and learning (PAL) and initial thinking time during the problem solving task (one of the executive functions) This is the first study in Serbia, which utilized the most reliable method of testing cognitive functions, to assess effects of ECT on memory and executive functions related to ECT treatment. Literature about efficacy of ECT in the treatment of MDD, was confirmed for the first time in Serbia. In addition, it has been shown that cognitive deficits associated with the disease, i.e. the acute phase of depression, improve during the recovery from depression treated with ECT, particularly in a field of visual memory and learning (PAL) and initial thinking time during the problem solving task (one of the executive functions). The current findings provide an important information for the clinical practice, ie. for the more effective and safer treatment approaches of depressive disorder utilizing currently underused method of treatment - electroconvulsive therapy.
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- 2016
27. Efekti kombinovane transkranijalne magnetne stimulacije i deprivacije spavanja u tretmanu major depresija
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Krstić, Jelena D., Ilić, Tihomir V., Nedeljković, Nadežda, and Špirić, Željko
- Subjects
major depresija ,deprivacija spavanja ,repetitive transcranial magnetic stimulation ,BDNF Val66Met genetic polymorphism ,repetitivna transkranijalna magnetna stimulacija ,major depression ,sleep deprivation ,BDNFVal66Met genetički polimorfizam - Abstract
Cilj rada. Cilj ovog rada je procena efekata kombinovane primene repetitivne transkranijalne magnetne stimulacije (rTMS) niske frekvencije (1 Hz) i parcijalne deprivacije spavanja (PDS) kod osoba obolelih od major depresije, koje prethodno pokazuju nezadovoljavajući odgovor na dva različita antidepresiva (ispunjavaju kriterijume terapijske rezistencije). Uporedo sa dugoročnim praćenjem (do 6 meseci) efekata ovog tretmana, analiziran je i genetički BDNF Val66Met polimorfizam, kao mogući perimisivni faktor plasticiteta odgovoran za predikciju efikasnosti primenjenih terapijskih strategija. Ispitanici i metode. Ukupno 20 osoba obolelih od major depresije, koje su ispunjavale kriterijume terapijske rezistencije tretirano je na navedeni način kombinacijom rTMS i PDS, uporedo sa njihovom prethodnom medikamentoznom terapijom. Kombinovani protokol rTMS i PDS sprovodio se tokom dve uzastopne nedelje, i za to vreme su ispitanici svakog dana, izuzev pauze za vikend dobijali stimulaciju rTMS (frekvencija 1 Hz, intenzitet 110% praga izazivanja motornog odgovora) primenjivanu iznad desnog dorzolateralnog prefrontalnog korteksa (DLPFK), u jutarnjim časovima. U svakoj nedelji po jednom, opisanoj rTMS, prethodila je redukcija noćnog spavanja uz buđenje u pola 2. Ispitanici su randomski podeljeni u grupu koja je primala rTMS+PDS i grupu koja je primala placebo (sham) rTMS stimulaciju + PDS. Procene efekta vršene su standardnim instrumentima kliničke procene (modifikovana Hamiltonova skala za procenu depresivnosti - HDRS-24; Montgomery-Asberg skala za procenu depresivnosti - MADRS, i skala opšteg kliničkog utiska), i to: pre početka primene protokola, neposredno po završetku, jednu nedelju kasnije, tri i šest meseci kasnije (dugoročna praćenja sprovedena su isključivo kod ispitanika koji su bili podvrgnuti aktivnom tretmanu). Rezultati. Primenjeni protokol stimulacije pokazao je antidepresivni efekat, kod osoba obolelih od unipolarne depresije na nepromenjenoj dozi antidepresivnih lekova koji se održavao tokom čitavog šestomesečnog perioda praćenja. Neposredno nakon 2 nedelje protokola ispitanici koji su primali aktivni rTMS imali su prosečno poboljšanje od 39%... Objectives. The main aim of this study was to evaluate potential synergistic antidepressant effect of two therapies: repetitive transcranial magnetic stimulation (rTMS) applied at 1 Hz associated with partial sleep deprivation (PSD) in patients with treatment resistant major depression. Besides the long- term (during the next 6 months) evaluation of effecacy of this treatment, potential predictive role of brain-derived neurotrophic factor (BDNF) Val66Met genetic polymorphism in rTMS treatment response was analysed, as a factor of neuronal plasticity, also involved in patogenesis of major depression Subjects and methods Twenty patients with diagnoses of treatment resistant major depression, at fixed doses of antidepressants, were treated with combination of rTMS and PSD. rTMS was applied during two consecutive weeks (5 days/week) with frequency of 1Hz, at 110% intensity of resting motor threshold, over the right dorso-lateral prefrontal cortex (DLPFC), in the morrning hours. Partial sleep deprivation was applied once during every week, as late partial sleep deprivation (patients were woke up at 01.30 a.m.). Patients were randomly assigned to receive rTMS+PSD, or sham+PSD. Clinical evaluation was done using the following rating scales: the modified Hamilton depression rating scale (HDRS-24), Montgomery-Asberg rating scale (MADRS ) and Clinical global impression scale (CGI-S), at baseline, after 2 weeks of treatment and one week after treatment, as well as long-term follow-up (only patients treated with active rTMS). Results. Study results suggest clinically relevant response, lasted up to 6 months in patients with unipolar major depression at fixed doses of antidepressants. After 2 weeks of treatment, patients treated with active rTMS had the average improvement of 39% score reduction on HDRS...
- Published
- 2012
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