Search

Introduction/Objective. Higher rates of morbidity and mortality from the infection of COVID-19 have been recorded among people with mental disorders, especially among those suffering from severe forms, so they should be prioritized during vaccination campaigns. The aim of this study was to examine possible predictors of acceptance of vaccination against COVID-19 in patients with mental disorders. Methods. This retrospective study was conducted from January 2021 until January 2022 and included 458 patients with mental disorders treated at the Dr Laza Lazarević Clinic for Mental Disorders in Belgrade, Serbia. Patients were segregated into the vaccinated and the unvaccinated group depending on their vaccination status. A questionnaire developed specifically for the present study was administered to gather the participants’ sociodemographic characteristics, while data related to their mental disorders, COVID-19 infection, and comorbidities was obtained from their medical records. Results. Eighty percent of the vaccinated group opted for the Sinopharm vaccine. Significantly higher percentage of vaccinated patients was hospitalized during the study period and had comorbidities compared to the unvaccinated group (51.4% vs. 32.6% and 52.8% vs. 37.5%, respectively). Education level, employment status, marital status, diagnostic category, and comorbidities were statistically significant predictors of COVID-19 vaccination uptake among people with mental disorders. Conclusion. Our findings show that higher level of education, greater trust in the healthcare system, and knowledge of the available vaccination points significantly contribute to the vaccination uptake in this vulnerable population group.

Introduction/Objective. Previous investigations pointed to a notable frequency of periodontitis appearance in persons with mental disorders, but almost none of them were addressed to the periodontitis among young adults with mental disorders as a target group, which can have high public health significance. Therefore, the aim of this investigation was to estimate the prevalence of periodontitis among young adults suffering mental disorders and to determine probable risk factors for their overall periodontal health. Methods. The investigation included two groups of patients, each group having 81 participants-the study group (young adults with mental disorders) and the control group (mentally healthy young adults). The study instruments included a questionnaire (age, gender, psychoactive substances use, and maintaining oral hygiene) and community periodontal index for both groups, and the data concerning primary disease of mentally deceased patients (diagnostic category, mental disorder duration, number of hospitalizations, and psychotropic medications). Results. In terms of psychoactive substances use and maintaining oral hygiene, statistically significant differences were observed between groups in all independent variables. Young adults with mental disorders shown a high prevalence of periodontitis compared to the mentally healthy young adults. Also, gender, smoking habits, and the use of antipsychotics exhibited as possible risk factors contributing current periodontal health of young mentally deceased patients. Conclusion. This study indicates the need for more consideration for periodontal health among people with mental disorders and determination of potential models for its improvement.

In clinical practice, involuntary hospitalization in psychiatry is a procedure that patients with severe mental disorders are subject to due to the inability to make rational treatment decisions.. The prevalence of involuntary hospitalizations varies widely within and between countries. Involuntary admission to a hospital for psychiatric treatment can be life-saving and may be considered beneficial to some people in the long run. However, the experience of involuntary treatment can be traumatic, intimidating, stigmatizing, and lead to long-term avoidance of mental health services and an increased risk of rehospitalization. In this paper, we have considered the risk factors for involuntary hospitalizations and their frequency in the region and Europe.

Introduction/Objective. Factors such as nature of psychiatric disorder, length of hospitalization and oralside effects of psychotropic medications may considerably contribute to high prevalence of oral diseases among people with schizophrenia, and a consequent need for prosthetic rehabilitation. The aim of this study was to ascertain the oral health level of prosthetic rehabilitated patients with schizophrenia and to consider their needs for future improvement of prosthetic rehabilitation. Methods. The study group comprised 52 patients with schizophrenia, hospitalized at the Dr Laza Lazarević Clinic for Mental Disorders, Belgrade. The control group comprised 52 patients with no psychiatric medical history, treated at the School of Dental Medicine, University of Belgrade. The oral health indices (Decayed, Missing and Filled Teeth Index – DMFT, Community Periodontal Index of Treatment Needs – CPITN, and the Simplified Oral Hygiene Index – OHI-S), socio-demographic characteristics, smoking habits, oral hygiene habits, and previous dental visits were registered in both groups, as well as medical characteristics of the primary disease in the study group patients. Results. Fifty percent of the study group patients had partial mobile dentures, while almost 30% had fixed dentures, in contrast to the control group patients, who prevalently had fixed dentures. In both groups of patients, a statistical significance was observed between partial mobile and fixed dentures wearers, in terms of DMFT index, carious teeth, CPI modified, and OHI-S. Similarly, a statistically significant difference between the groups was observed concerning fixed dentures in terms of carious teeth, filled teeth, CPI modified, and OHI-S. Conclusion. Multidisciplinary approach is needed for complete oral and prosthetic rehabilitation of this group of psychiatric patients.

Introduction/Objective. Previous studies suggest that the number of suicides and suicide attempts will increase due to the COVID-19 pandemic. The aim of this study was to investigate the impact of the COVID-19 pandemic on the frequency and characteristics of suicide attempts in the Republic of Serbia. Methods. The study observed two periods: the period from March to August 2020 (the COVID period) and the same period of the previous year (the non-COVID period). The observation during the mentioned periods encompassed patients who were examined at the Dr. Laza Lazarević Clinic for Mental Disorders in Belgrade due to suicide attempts (1987 persons during COVID period and 2300 persons during the non-COVID period). Results. Concerning suicide attempts, a statistically significant difference between the observed periods was registered in respect to the total number of monthly clinical examinations, monthly distribution of suicide attempts, patients’ gender and age, mode of suicide attempt, and the diagnostic category. Binary logistic regression determined that statistically significant factors that can influence the suicide attempt were year, months, patients’ gender and age, and diagnostic category. Conclusion. COVID-19 pandemic creates the increased exposure of the people to suicide risk factors, which points to the significance of consistent monitoring of mental health during the COVID-19 pandemic and thereafter.

World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern. Mental health strategies implemented due to the coronavirus epidemic must include the assessment of mental health status of people in different subpopulations influenced by the COVID-19 outbreak, identifying persons who are at high risk of manifesting behavior disorders, suicide attempt, and aggression in aim of providing appropriate mental health care interventions for those in need. The target population of these mental health strategies is categorized in four different groups: the most vulnerable people with mental health problems, isolated people with symptoms of atypical acute respiratory infection, individuals who have been in close contact with the previous two categories, and people affected by the preventive and restrictive measures.

Background/Aim. According to the World Health Organization (WHO), there is an increasing prevalence of mental disorders among children and adolescents worldwide. Previous studies have shown that people with mental disorders, regardless age, have an increased prevalence of dental caries due to several reasons. The aim of this study was to determine prevalence of dental caries in adolescents with mental disorders and to consider possible risk factors that might contribute to their current dental health status. Methods. The study was conducted as an observational cross-sectional study. The study group comprised 70 randomly selected hospitalized adolescents with mental disorders. The control group comprised 70 randomly chosen mentally healthy adolescents. They were matched to the study group by gender and age. All the participants were subjected to targeted dental examination according to criteria recommended by the WHO. Collection of data related to mental disorders of the study group was obtained from the patient’s medical records. All collected data were organized and analyzed by descriptive statistical parameters and regression models. Results. Majority of the study group patients were diagnosed with schizophrenia, schizotypal and delusional disorders (F20-F29), as well as behavioral and emotional disorders usually occurring in childhood and adolescence (F90-F98). Almost 90% of them were treated with antipsychotics of the second generation, as monotherapy or in combination with first-generation antipsychotics. Adolescents with mental disorders had significantly more carious and extracted teeth and three times less filled teeth than mentally healthy adolescents in the control group. The mean value of the decay-missing-filled teeth (DMF) index in the study group patients was also significantly higher than the mean value of DMF index in the control group subjects. Conclusion. It seems that mental disorder among adolescents mainly affects oral health indirectly, decreasing motivation of patients in maintaining oral hygiene.

Introduction/Objective. Although effectiveness of atypical antipsychotics in patients with schizophrenia is mostly similar, there are significant differences in adverse effects rate and treatment costs, making comparison of their cost/effectiveness ratios essential for optimal drug choice. The aim of this study was to compare cost/effectiveness of aripiprazole and olanzapine in long-term treatment of schizophrenia. Methods. A four-state, three-month cycle Markov model was built to compare aripiprazole and olanzapine. The model assumed that patients who relapse on treatment with both aripiprazole and olanzapine are further treated with clozapine. The perspective of the National Health Insurance Fund was chosen, and the period covered by the model was 10 years. The model results were obtained after Monte Carlo microsimulation of a sample with 1,000 virtual patients. Both multiple one-way and probabilistic sensitivity analysis was made. Results. After base-case analysis aripiprazole was dominated by olanzapine, as net monetary benefit was negative (-390,341.96 Ѓ} 29,131.53 RSD) and incremental cost/effectiveness ratio (ICER) was above the willingness-to-pay line of one Serbian gross domestic product per capita per quality-adjusted life year (QALY) gained. Multiple one-way and probabilistic sensitivity analysis confirmed results of the base case simulation. Conclusion. Olanzapine has more beneficial cost/effectiveness ratio than aripiprazole for long-term treatment of schizophrenia in Serbian milieu. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175007]

Introduction. Patients with schizophrenia are likely to constitute a high-risk group of individuals with respect to prevalence of oral diseases and they require special attention. Factors like nature of psychiatric disorders, length of stay and oral-side effects of psychotropic medications have been noted as contributors to poor oral health among institutionalized chronic psychiatric patients. Methods. This cross-sectional study comprised 190 inpatients with schizophrenia at the Dr Laza Lazarevic Clinic for Mental Disorders in Belgrade, and 190 mentally healthy patients at the Clinic for Periodontology and Oral Medicine, School of Dental Medicine, University of Belgrade. A questionnaire was designed for the purpose of this research with the aim of recording information on demographic data (age and sex), unhealthy habits (tobacco smoking, alcohol consumption and drug abuse), and data about the existence of any oral symptom and/or sings related to oral soft tissue pathology. All participants were subjected to targeted clinical examinations. Results. All study group patients were receiving psychotropic medications (mean number 4.18 ± 1.14; from 1 to 7 medications). The study group patients had a total of 272 symptoms and 121 signs of oral disorders; which was almost four times higher for symptoms and even nine times higher for signs of oral disorders than in the control group. Conclusion. Schizophrenia as a mental disorder does not directly affect the condition of oral health of this group of psychiatric patients, but indirectly – reducing their motivation and awareness of the importance of oral health, which is particularly emphasized in hospital conditions.

Introduction/Objective. During the past 20 years, there have been numerous attempts to design and apply a simple, affordable blood analysis tool for diagnostic and prognostic purposes in psychiatry. In this article we demonstrate that some mathematical parameters of chromatin organization and distribution in blood neutrophil granulocytes are related to stress levels in patients diagnosed with recurrent depressive disorder (RDD). Methods. The study was performed on 50 RDD participants who were asked to complete Depression, Anxiety and Stress Scales (DASS-21). Peripheral blood samples were obtained from all the participants, smeared on glass slides and stained using a modification of Giemsa method. A total of 500 representative chromatin structures (10 per patient) of neutrophil granulocytes were evaluated using textural analysis with the application of gray level co-occurrence matrix (GLCM) method. Parameters such as angular second moment (indicator of textural uniformity), inverse difference moment (textural homogeneity), and textural sum variance were calculated. Results. The results indicate that there is a statistically highly significant correlation (p < 0.01) between certain chromatin GLCM parameters such as inverse difference moment, and DASS-21 stress score. There was also a significant difference (p < 0.05) in some chromatin GLCM parameters in patients diagnosed with RDD with psychotic features, when compared to the ones without psychosis. Conclusion. These findings suggest that in the future, chromatin GLCM features might have a certain predictive value for some clinical features of recurrent depressive disorder.

Background/Aim. Adherence to the guidelines of Good Clinical Practice (GCP) during the treatment of specific disorders is considered a guarantee of the implementation of a uniform, evidence-based clinical practice in psychiatry. The aim of this study was to analyze the concordance of prescribing patterns of antipsychotic drugs with the recommendations of good clinical practice in Serbia and an insight into the effects that introduction of the National Guideline for the Diagnosis and Treatment of Schizophrenia had on the prescribing practice in this area. Methods. Noninterventional, observational study was conducted at the Clinic for Mental Disorders “Dr Laza Lazarević” in Belgrade. It included a consecutive sample of 675 previously untreated patients, hospitalized from January 1st, 2012 to December 31st, 2015, dismissed with a discharge diagnosis of any of schizophrenia spectrum disorders. The data about demographic and clinical characteristics of patients, characteristics of prescribers and prescribed antipsychotics were obtained retrospectively, from the patients’ medical records. For the analysis of primary data, the descriptive statistical methods and methods for testing statistical hypotheses were used. A method of logistic regression was used to identify the factors associated with adherence to the GCP recommendations. Results. Totaly, 446 (66.1%) of subjects were treated with antipsychotic monotherapy. After the introduction of National Guideline for the Diagnosis and Treatment of Schizophrenia prescribing of second generation antipsychotic monotherapy (78.41% vs. 63.5%, respectively; p < 0.001) increased significantly compared to the previous period. The factors independently associated with adherence to the recommendations of the GCP were the year of hospitalization, the age of the prescriber, and the age and education of the patient. Conclusion. After the introduction of the National Guide to Good Clinical Practice for the Diagnosis and Treatment of Schizophrenia there have been significant, but insufficient changes in the prescribing patterns of antipsychotics during the treatment of the first psychotic episode in Serbia.

Background/Aim. Many studies on oral health of psychiatric inpatients reported schizophrenia as the most common psychiatric disorder among their sample population. The available evidence suggests the higher prevalence and severity of periodontal disease among the psychiatric inpatients. The aim of this study was to evaluate periodontal health among the inpatients with schizophrenia and to consider possible risk factors for their current periodontal diseases. Methods. This cross-sectional study comprised 190 inpatients with schizophrenia at the Clinic for Psychiatric Disorders “Dr Laza Lazarevic” in Belgrade, and 190 mentally healthy patients at the Clinic for Periodontology and Oral Medicine, Faculty of Dental Medicine, University in Belgrade. The Community Periodontal Index for Treatment Needs (CPITN) and sociodemographic characteristics were registered in both groups as well as the characteristics of the primary disease among the inpatients with schizophrenia. Results. The patients in the study group had significantly higher scores of the CPITN (2.24 ± 0.98) than the patients in the control group (1.21 ± 1.10). Most of the patients in the study group had supra- , or subgingival calculi (46.8%), in contrast to the control group patients, who had in most cases gingival bleeding (45.8%). The periodontal pockets where detected in 35.8% of schizophrenic inpatients. The linear regression analysis showed that the gender and age were statistically significant predictors of the CPITN value among the inpatients with schizophrenia. Conclusion. The results of this study generally indicate the need for continuous research of psychiatric patients’ oral health, in order to determine the modes of its improvement. Similar studies should elucidate significance of psychiatric patients’ periodontal health and sensitize psychiatrists and psychiatric nurses to the oral problems of their patients.

“Reading the Mind in the Eyes” test (RMET) is one of the most popular and widely used measures of individual differences in Theory of Mind (ToM) capabilities. Despite demonstrating good validity in differentiating various clinical groups exhibiting ToM deficits from unimpaired controls, previous studies raised the question of the RMET’s homogeneity, latent structure, and reliability. The aim of this study is to provide evidence on psychometric properties, latent structure, and validity of the newly adapted Serbian version of the RMET. In total, 260 participants (61.9% females) took part in the study. The sample consisted of both unimpaired controls (76.5%), and a clinical group of participants that are believed to demonstrate ToM deficits (23.5%), namely, persons diagnosed with schizophrenia and bipolar disorder (54.1% females). RMET has demonstrated fair psychometric properties (KMO = .723; α = .747; H1 = .076; H5 = .465), successfully differentiating between clinical group and control [F (1,254) = 26.175, p

Delirium is connected to bad short-term (the increase in hospital mortality rate and hospital days) and long-term outcomes (disfunctionality, institutionalisation, cognitive damage and post hospital-release dementia). The objective of this study is to determine whether there are possible incompatibilities of treatment of delirium with the recommendations in the guides of good clinical practice from developed countries. The grounded method was used in the study. The so called principal sampling of 17 psychiatrists, anesthesiologists and registered nurses was conducted. Afterwards, the unstructured interviews with the selectees were conducted, transcribed and analyzed immediately through coding, category and concept detection. Having completed this, the theoretical sampling of new interview examinees was conducted. Their analysis enabled the concepts to be linked into a working theory and graphically displayed. The new sampling, the new interviews and their analysis were then continued interactively until the saturation of the working theory was achieved and the final version of the theory was formulated based on the findings reached through the interviews. Having completed the principal sampling and coding of the transcripts led the researches to the saturation of the theory through the separation of eight categories: A - Delirium as a sign of system infection, B - Therapy - Anaesthesiologists administer benzodiazepines, whereas psychiatrists administer antipsychotics, C - An inconspicuous onset of delirium is overlooked, D - Bleeding as the cause of delirium, E -Anticholinergics as a cause of delirium, F - Misunderstanding the nature of delirium by anaesthesiologists, G -Being aware that the patient is vitally endangered, and H - The nurses apply enhanced health care measures. Delirium is a syndrome which can be prevented in 30 -40% of cases (50). An etiological treatment would help avoid complicating delirium's clinical picture and would very much prevent poor outcomes, such as institutionalisation, cognitive damage and delirious patients' high mortality rate.

Background/Aim. Delirium is an acute or subacute, and most frequently reversible syndrome of higher cortical functions disturbances that is manifested as generalized disorder. If not prevented, it is associated with various adverse outcomes. The aim of this study was to determine the connection between the markers of inflammation and lethal outcome in patients diagnosed with delirium, hospitalized in the psychiatric intensive care unit. Methods. This retrospective study included 120 patients hospitalized in the psychiatric intensive care unit in whom examination of differences in inflammation markers was done. The examinees have been divided into two groups: the case group of 40 patients who died during the hospitalization, and the control group of 80 examinees who were discharged with the diagnosis Post delirium status. The following variables were taken into account: age, gender, clinical diagnosis of infection (pneumonia and urinary tract infection), laboratory parameters (total of white blood cells, granulocytes, monocytes, C-reactive protein − CRP) and type of delirium (withdrawal or organic). Results. The average age of patients was 50.3 ± 13.1 years. The patients who survived delirium, were on the average 10.5 years younger than the deceased (p < 0.001). More than half (57.5%) of the deceased had pneumonia. There was a statistically significant correlation between pneumonia and lethal outcome in the patients with delirium (p < 0.001). The examinees with lethal outcome had significantly higher median CRP levels than the group of examinees who survived (75.6% ± 54.0 vs 30.3 ± 42.5 ng/L, p < 0.001). Conclusion. Aiming to better and more precise diagnostics of this complicated and still unclear neuropsychiatric syndrome it would be useful to consider introduction of more precise diagnostic algorithms in every unit of intensive care. That would significantly reduce the number of delirium diagnosis overlook, decrease complication of clinical features and would also reduce the unfavorable outcome rate, therefore the total cost of treatment.

Objective: The great discrepancy between clinical guidelines and the routine psychiatric practice in the treatment of schizophrenia is a subject of intensive research, with the aim to promote the rational prescribing of antipsychotics. The aim of this study was to analyze the pattern of drug prescribing in the treatment of inpatients with the first episode of schizophrenia spectrum disorders and the impact of the implementation of the Serbian National Guideline for the Diagnosis and Treatment of Schizophrenia., Materials and Methods: This cross-sectional study was conducted at the Clinic for Mental Disorders "Dr Laza Lazarević" in Belgrade and included a consecutive sample of 675 previously drug-naïve patients with the first episode of schizophrenia spectrum disorders. The data were obtained from the patients' medical records. The analysis of therapy prescribed at discharge included antipsychotics and non-antipsychotic adjuvant therapy. Descriptive statistical methods and methods for testing statistical hypotheses were used to analyze the primary data., Results: The prescribing of second-generation antipsychotics has increased both within antipsychotic monotherapy and within antipsychotic polypharmacy during the period of the study. The use of adjuvant non-antipsychotic pharmacotherapy was very common, but use of benzodiazepines, carbamazepine, and anticholinergic drugs significantly decreased. Long-acting forms of antipsychotics have been rarely used (9.3%). Clozapine was in general underprescribed (10.4%)., Conclusion: The National Guideline for the Diagnosis and Treatment of Schizophrenia most likely contributed to some positive changes in prescribing patterns during the treatment of the first psychotic episode in daily clinical practice in Serbia. However, antipsychotic polypharmacy and irrational use of adjuvant therapy was still prevalent.