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Use of new psychoactive substances among the general population in Croatia: Patterns of use and sociodemographic characteristics of users 克罗地亚普通民众对新型精神活性物质的使用:使用模式和使用者的社会人口特征
Pub Date : 2018-06-15 DOI: 10.20471/may.2018.54.01.01
Renata Glavak Tkalić
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引用次数: 3
Population Drinking and Gender Gap in Suicide Mortality in Russia 俄罗斯人口饮酒与自杀死亡率的性别差异
Pub Date : 2017-12-15 DOI: 10.20471/DEC.2017.53.02.02
Y. Razvodovsky
Correspondence to: Yury E. Razvodovsky Grodno State Medical University, Belarus Gorky Street, Grodno 230009, Belarus tel.: + 375 0152 70 18 84, fax: +375 0152 43 53 41, e-mail: razvodovsky@tut.by Copyright © 2017 KBCSM, Zagreb e-mail: alcoholism.kbcsm@gmail.com • www.http//hrcak.srce.hr/acoholism Abstract: Across most countries, suicide rates are significantly higher for men compared to women, while women typically have higher rate of suicide attempts. The gender difference in the suicide rates is particularly large in the Eastern European countries. There is suggestive evidence of a crucial role of alcohol in explanation of this phenomenon. In present study we will test the hypothesis of the close aggregate level link between alcohol consumption and gender difference in suicide mortality rates in Russia using data on sex-specific suicide rates and alcohol consumption per capita between 1965 and 2015. Time-series analytical modeling techniques (ARIMA) were used to examine the relation between the gender gap in suicide mortality and trends in alcohol consumption per capita. According to the results of time-series analysis, alcohol consumption is a statistically significant factor associated with gender gap in suicide mortality in Russia, implying that a 1-litre increase in consumption per capita is associated with an increase in the difference between male and female suicide mortality rates by 8.3%. The results of the analysis also suggest that 66 % of the difference in suicide mortality between males and females in Russia could be attributed to alcohol. The outcomes of this study provide indirect support for the hypothesis that alcohol is a major contributor to the high gender gap in suicide mortality and its dramatic fluctuations in Russia during the last few decades.
通信:Yury E. Razvodovsky格罗德诺国立医科大学,格罗德诺230009,白俄罗斯高尔基街电话:+375 0152 70 18 84,传真:+375 0152 43 53 41,电子邮件:razvodovsky@tut.by版权所有©2017 KBCSM,萨格勒布电子邮件:alcoholism.kbcsm@gmail.com•www.http//hrcak.srce.hr/acoholism摘要:在大多数国家,男性的自杀率明显高于女性,而女性通常有更高的自杀企图率。在东欧国家,自杀率的性别差异尤其大。有证据表明,酒精在解释这一现象中起着至关重要的作用。在本研究中,我们将使用1965年至2015年间的性别自杀率和人均酒精消费量数据,检验酒精消费与俄罗斯自杀死亡率性别差异之间密切总体水平联系的假设。时间序列分析建模技术(ARIMA)用于检查自杀死亡率的性别差距与人均酒精消费量趋势之间的关系。根据时间序列分析的结果,酒精消费在统计上是与俄罗斯自杀死亡率性别差异相关的重要因素,这意味着人均饮酒量每增加1升,男性和女性自杀死亡率之间的差异就会增加8.3%。分析结果还表明,俄罗斯男性和女性之间66%的自杀死亡率差异可归因于酒精。这项研究的结果间接地支持了这样一种假设,即酒精是过去几十年来俄罗斯自杀死亡率的性别差异及其剧烈波动的主要原因。
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引用次数: 2
Malignant Diseases as Cause of Death in 92 Composers / Musicians (addictions included) 92位作曲家/音乐家因恶性疾病死亡(包括成瘾)
Pub Date : 2017-12-15 DOI: 10.20471/DEC.2017.53.02.06
D. Breitenfeld, T. Breitenfeld, M. Vodanović, Mislav Pap, J. Grah, S. Špoljar, Ankica Akrap, Ivan Resetar
Darko Breitenfeld1, Tomislav Breitenfeld2, Marijo Vodanović3, Mislav Pap4, Josip Joachim Grah5, Sanja Špoljar1, Ankica Akrap1, Ivana Rešetar1 1Croatian Physicians′ Music Society, CMA, Zagreb, Croatia; 2Department of Neurology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia; 3University Hospital Centre, Department of Internal Medicine, Division of Hematology, Zagreb, Croatia; 4 Department of Rheumatic Diseases and Rehabilitation, University Hospital Centre, Zagreb, Croatia; 5Department of Oncology, Division of Planning and Implementation of Radiotherapy, University Hospital Centre , Zagreb, Croatia Pathographies
Darko Breitenfeld1、Tomislav Breitenfield2、Marijo Vodanović3、Mislav Pap4、Josip Joachim Grah5、SanjaŠpoljar1、Ankica Akrap1、Ivana Rešetar1克罗地亚医师音乐协会,CMA,克罗地亚萨格勒布;2克罗地亚萨格勒布Sestre milosrdnice大学医院中心神经内科;3克罗地亚萨格勒布大学医院中心血液科内科;4克罗地亚萨格勒布大学医院中心风湿病和康复科;5克罗地亚萨格勒布大学医院中心肿瘤科放射治疗规划和实施处病理学
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引用次数: 0
Severe Hyponatremia and Water Intoxication – Diagnostic Challenge in Department of Emergency Medicine 严重低钠血症和水中毒——急诊科的诊断挑战
Pub Date : 2017-12-15 DOI: 10.20471/DEC.2017.53.02.05
J. Pupić-Bakrač, J. Radovic, Ana Pupić-Bakrač, D. Markota, Dušan Pupić-Bakrač
Correspondence to: Jure Pupić-Bakrač, Department of Emergency Medicine, University Clinical Hospital Mostar, Bijeli Brijeg bb, 88 000 Mostar, Bosnia and Herzegovina Telephone: +385989764788 E-mail: jureppbkr2@gmail.com Copyright © 2017 KBCSM, Zagreb e-mail: alcoholism.kbcsm@gmail.com • www.http//hrcak.srce.hr/acoholism Abstract Psychogenic polydipsia is a disorder characterized by compulsive drinking of water in a population of psychiatric patients, most often those suffering from chronic psychosis. It can lead to severe dilutional hyponatremia and water intoxication, which is manifested by cerebral edema and associated neurological symptomatology. A 43 years-old patient was admitted to the Department of Emergency Medicine due to convulsions of the right hand and leg, which began one hour before arrival. During the episode, the patient was conscious, vomited once and had urinary incontinence. In the medical history he had epilepsy, chronic psychosis and moderate mental retardation. Vital parameters were stable, and physical examination did not reveal any associated pathological signs. Samples for laboratory analysis were taken and therapy with infusions of Diasepam (20 mg) included, to which patient was resistant. By heteroanamnesis it was acknowledged that in the last few days he spent more time than usual drinking water. Reviewing laboratory results it was found out that sodium concentration was 98 mmol/L. We began the gradual correction of sodium, after which the patient reached the full extent of recovery. Water intoxication is an emergency condition that is in clinical practice often mistaken for other neurological and internal emergency states, because of its non-specific symptomatology. With timely diagnosis and application of adequate treatment, recovery is complete.
通讯:Jure Pupić-Bakrač,莫斯科大学临床医院急诊科,Bijeli Brijeg bb,88000 Mostar,波斯尼亚和黑塞哥维那电话:+385989764788电子邮件:jureppbkr2@gmail.com版权所有©2017 KBCSM,萨格勒布电子邮箱:alcoholism.kbcsm@gmail.com•www.http://hrcak.sec.hr/酒精抽象精神源性多饮症是一种精神病患者群体中以强迫饮水为特征的疾病,通常是患有慢性精神病的患者。它可导致严重的稀释性低钠血症和水中毒,表现为脑水肿和相关的神经症状。一名43岁的患者因右手和右腿抽搐入院,抽搐在抵达前一小时开始。在发作期间,患者意识清醒,有一次呕吐,并出现尿失禁。在病史上,他有癫痫、慢性精神病和中度智力迟钝。生命参数稳定,体格检查未发现任何相关的病理体征。采集用于实验室分析的样本,并包括患者对其具有耐药性的双司帕姆(20 mg)输注治疗。通过异记忆,人们承认在过去的几天里,他花在喝水上的时间比平时多。回顾实验室结果,发现钠浓度为98mmol/L。我们开始逐步纠正钠,之后患者达到了完全康复的程度。水中毒是一种紧急情况,在临床实践中,由于其非特异性症状,经常被误认为是其他神经和内部紧急状态。经过及时诊断和充分治疗,完全康复。
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引用次数: 1
Burnout Syndrome in Mental Health Professionals: psychiatric hospital setting 精神卫生专业人员的职业倦怠综合征:精神病院设置
Pub Date : 2017-12-15 DOI: 10.20471/dec.2017.53.02.03
I. Velimirović, Mirta Vranko, M. Ferić, T. Jendričko
Correspondence to: Tihana Jendričko University Psychiatric Hospital Vrapče, Bolnička cesta 32, Zagreb, Croatia e mail: tjendricko@gmail.com Copyright © 2017 KBCSM, Zagreb e-mail: alcoholism.kbcsm@gmail.com • www.http//hrcak.srce.hr/acoholism Abstract Burnout is frequently mentioned as a problem in the mental health field. As a type of prolonged response to chronic job-related stressors, has a special significance in health care where staff experience both psychological-emotional and physical stress. The aim of the paper was to determine the level of stress in professionals working in psychiatric hospital, as well as to explore possible differences in stress level regarding the different characteristic of participants as sex, level of education, marital status, working hours etc. The Burnout Clinical Subtypes Questionnaire was used. Study was conducted from July to December 2014, and from April to May 2015. The sample of 141 participants who work in mental health profession consists of 39.9% male and 68.1% female, average age of 38.98 years. Overall results show that participants have lower scores on all subscales. The results showed that there is moderate burnout experience in the sense that participants feel overload when they try to maximize their reward by taking on a volume and pace of work that become excessive. This questionnaire can be a very useful instrument for future evaluation and designing interventions and different treatment strategies for subtypes of burnout.
通信:Tihana jendriko大学精神病院vrap, bolni ka cesta 32,萨格勒布,克罗地亚e-mail: tjendricko@gmail.com版权所有©2017 KBCSM,萨格勒布e-mail: alcoholism.kbcsm@gmail.com•www.http//hrcak.srce.hr/acoholism摘要倦怠是心理健康领域经常提到的一个问题。作为对慢性工作相关压力源的一种长期反应,在工作人员经历心理-情绪和身体压力的卫生保健中具有特殊意义。本文的目的是确定在精神病院工作的专业人员的压力水平,并探讨参与者的不同特征(如性别、教育水平、婚姻状况、工作时间等)在压力水平上可能存在的差异。采用倦怠临床分型问卷。研究时间为2014年7月至12月,2015年4月至5月。141名心理卫生专业从业人员中,男性占39.9%,女性占68.1%,平均年龄38.98岁。总体结果显示,参与者在所有子量表上的得分都较低。结果显示,当参与者试图通过承担过多的工作量和速度来最大化自己的回报时,他们会感到超负荷,这是一种适度的倦怠体验。这份问卷可以作为一个非常有用的工具,为未来的评估和设计干预措施和不同的治疗策略的亚型倦怠。
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引用次数: 1
The Role of Thrombocyte Serotonin System and Some Thrombocyte Characteristics in Treatment of Depressive Patients with Cardiovascular Diseases 血小板5 -羟色胺系统及某些血小板特征在抑郁症合并心血管疾病患者治疗中的作用
Pub Date : 2017-06-26 DOI: 10.20471/APR.2017.53.01.04
Lidija Kostanjšak, D. Zdunić
IntroductionAmong the known neurotransmitters, serotonin, norepinephrine and dopamine play the important roles in the development of psychiatric disturbances. The research so far has shown that this is not the matter of concentrations themselves, but of disbalance of concentrations between the neurotransmitter systems in CNS (central nervous system). There is proof that there is a decrease of serotonin, epinephrine and dopamine functions in patients suffering from the recurring depressive episodes, while there is a hyperactivity of norepinephrine and dopamine system in patients suffering from the bipolar affective disorder [1]. There is still a dilemma if there were a hypo or hyperactivity of serotonin system in generalized anxiety disorder [2,3]. The agonists of 5HT1A receptors reduce the symptoms of panic disorders, while the activation of 5HT2C receptors induces a panic attack [4]. Hypersensitivity of postsynaptic serotonin receptors plays an important role in obsessive-compulsive disorders [5]. Destabilization of serotonin system has been noted also in posttraumatic stress disorders. This fact had been confirmed by the efficiency of SIPPS in its treatment [6]. Dysfunction of serotonin system is also present in some personality disorders, urge-control disturbances, feeding disorders and dementia. It seems that the negative symptoms in schizophrenia are due to a dysfunction of serotonin system. In suicidal tendencies, the role of serotonin system is of the greatest importance and numerous post-mortem investigations had revealed lower concentrations of serotonin and its main metabolite 5-hydroxyindolacetate acid (5-HIAA) in brainstem, nuclei raphe, putamen and hypothalamus [7]. Some research show that lower levels of thrombocyte serotonin are connected with suicidal behaviour of depressive patients [8]. Numerous investigations have shown that, among the patients who had suffered a myocardial infarction or other diseases of cardiovascular system we can find depressive symptoms in the frame of depressive reaction, but also a real depression in its fully-blown clinical form. Depression slows the recovery in those patients but, even more importantly, some indices had been found in patients suffering from depression that it could be directly connected with an increased risk for the development of cardiovascular diseases and complications during recovery. Thrombocyte serotonin is a strong vasoconstrictor and the research has shown that the treatment with selective inhibitors of serotonin uptake (SIPPS) causes lowering of its concentration, thus reducing its role in increasing the cardiovascular risk and causing the complications of recovery. Also, the treatment of depressive patients with SIPPS lowers the values of MPV (mean platelet volume, mean thrombocyte cell volume), which had been recognized as an independent risk factor for the development of myocardial infarction and stroke.Serotonin system in thrombocytesEnterochromafine cells are the only ce
引言在已知的神经递质中,血清素、去甲肾上腺素和多巴胺在精神障碍的发展中起着重要作用。迄今为止的研究表明,这不是浓度本身的问题,而是中枢神经系统中神经递质系统之间浓度不平衡的问题。有证据表明,反复发作的抑郁症患者的血清素、肾上腺素和多巴胺功能下降,而双相情感障碍患者的去甲肾上腺素和多巴胺系统过度活跃[1]。在广泛性焦虑症中,血清素系统是否存在低水平或多动症仍然存在困境[2,3]。5HT1A受体的激动剂可减轻惊恐障碍的症状,而5HT2C受体的激活可诱导惊恐发作[4]。突触后血清素受体的超敏反应在强迫症中起着重要作用[5]。5-羟色胺系统的失稳也在创伤后应激障碍中被注意到。SIPPS的治疗效果已经证实了这一事实[6]。血清素系统的功能障碍也存在于一些人格障碍、冲动控制障碍、进食障碍和痴呆症中。精神分裂症的负面症状似乎是由于血清素系统的功能障碍。在自杀倾向中,血清素系统的作用最为重要,大量尸检显示,脑干、中缝核、壳核和下丘脑中血清素及其主要代谢产物5-羟基吲哚乙酸(5-HIAA)的浓度较低[7]。一些研究表明,血小板血清素水平较低与抑郁症患者的自杀行为有关[8]。大量研究表明,在患有心肌梗死或其他心血管系统疾病的患者中,我们可以在抑郁反应的框架内发现抑郁症状,但也可以发现真正的抑郁症。抑郁症会减缓这些患者的康复,但更重要的是,在抑郁症患者中发现的一些指标表明,抑郁症可能与康复期间心血管疾病和并发症的风险增加直接相关。血栓细胞血清素是一种强大的血管收缩剂,研究表明,用选择性血清素摄取抑制剂(SIPPS)治疗会降低其浓度,从而降低其在增加心血管风险和导致康复并发症中的作用。此外,SIPPS治疗抑郁症患者降低了MPV(平均血小板体积、平均血小板细胞体积)的值,MPV已被认为是心肌梗死和中风发展的独立风险因素。血小板中的血清素系统肠色氨酸细胞是除5HT神经元外唯一合成血清素的细胞。它们将其释放到血流中,从那里与转运蛋白结合,主要进入血小板。血栓细胞中的血清素系统与神经元中的血清素非常相似。它是血小板反应机制的一部分,实际上是血小板形状变化和聚集的过程[9,10]。血栓形成细胞含有循环中约99%的总血清素,因此在生理条件下,血浆血清素水平反映了血栓形成细胞中血清素的浓度。人类血栓细胞平均每109个血栓细胞含有150至600 ng 5-羟色胺[11]。血小板的血清素系统由:血清素跨膜载体(转运蛋白)、血清素受体、单胺氧化酶和储存在德尔塔颗粒中的血清素组成。血清素通过两种载体的作用进入血小板并聚集[12]。蛋白质5-HT载体(5HTt)位于血小板膜上,能够将血清素和其他内源性胺(如多巴胺)从血浆摄入到血小板的细胞质液[13]…
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引用次数: 5
Digestive diseases of 80 composers (addictions included) 80位作曲家的消化系统疾病(包括成瘾)
Pub Date : 2017-06-26 DOI: 10.20471/apr.2017.53.01.06
D. Breitenfeld, R. Pulanić, Mislav Pap, Ankica Akrap, B. Grgić, Ivan Resetar
Correnspodence to: Darko Breietenfeld Derenčinova 25, 10000 Zagreb, Croatia e-mail: darko.breitenfeld@gmail.com Copyright © 2017 KBCSM, Zagreb e-mail: alcoholism.kbcsm@gmail.com • www.http//hrcak.srce.hr/acoholism Abstract – Based on study of pathographies we noticed eighty cases of digestive diseases among composers. The most important composers are presented in the form of short pathographies, and the others were briefly mentioned in the following list. Mentioned diseases influenced the creativity of composers and their life expectancy.
Correnspodence to:Darko Breietenfeld Derenčinova 25,10000萨格勒布,克罗地亚电子邮件:darko.breitenfeld@gmail.com版权所有©2017 KBCSM,萨格勒布电子邮箱:alcoholism.kbcsm@gmail.com•www.http://hrcak.sec.hr/共病摘要-根据对病理学的研究,我们注意到作曲家中有80例消化系统疾病。最重要的作曲家以简短的悲情曲的形式呈现,其他作曲家在以下列表中被简要提及。提到的疾病影响了作曲家的创造力和他们的预期寿命。
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引用次数: 1
The Impact of Obesity on Suicidality among Female Patients Suffering from Bipolar Affective Disorder: The Indirect Role of Body Dissatisfaction 肥胖对女性双相情感障碍患者自杀的影响:身体不满意的间接作用
Pub Date : 2017-06-26 DOI: 10.20471/APR.2017.53.01.01
S. V. Pisk, M. Mihanović, I. Filipčić, A. Bogović, N. Ruljancic
IntroductionObesity is becoming a growing public health challenge and a preventive and therapeutic priority among the adult population, with a significant increase in prevalence recorded over the past two decades [1-3]. Obesity not only constitutes a serious health threat, it is also comorbid with other medical conditions, including psychiatric disorders [4-11]. One of the most frequent methods for establishing obesity is the measurement of the BMI (Body Mass Index), expressed as mass in kilograms over height in meters squared [12-13]. Obesity is a frequent condition among persons suffering from Bipolar Affective Disorder (BAD) and is associated with significant impairments in quality of life as a result of increased body weight [14-16]. It is significantly correlated with disorder outcome among patients suffering from BAD [17]. Obese persons, in comparison with those of average body weight, experience a greater number of depressive and manic episodes during their lifetime, and their clinical presentations have a higher intensity of symptoms and more frequent depressive residues [18-22].Obesity is associated with several significant psychological and social factors such as poorer quality of life, deficient social functionality, greater sense of dissatisfaction, lowered self-esteem, and poorer overall bodily health [23-26]. Current cultural norms encourage the ideal of a slim body build. Contemporary Western cultures deem obese persons to be responsible for their state, and they promote an attitude of personal responsibility for many aspects of life including the control of body weight and appearance. As a result of these cultural assumptions, obese people are often described as "lazy, ugly and stupid." Obese persons therefore, often experience discrimination and are stigmatized in their professional and private lives. Taking into consideration these negative attributions, it is logical that obese persons face an increased risk of developing various disorders, including severe, mental disorders and suicidal behaviors [20-27].Suicidal behavior is defined as encompassing a broad semantic spectrum: from suicidal ideation, verbalization, planning, intent and self-harming to attempted suicides and their execution, i.e., committing suicide. Suicidal behavior is an etiologically complex phenomenon predicated on biological, environmental, developmental and learned factors [28-31]. With BAD, there is a high rate of suicidal risk of approximately 15 percent. Suicidal behaviors are the third leading general cause of mortality, and the third leading cause of mortality in the 15- to 24-year-old age group [21,24,32-35].In similar studies of large, nationally representative sample groups (over 40,000 people), Carpenter et al. found a gender-dependent correlation between obesity and depression. Among a group of obese women, 37% had experienced a severe depressive episode, 20% had experienced suicidal ideation, and 23% had attempted suicide in the past year. Among
引言肥胖正在成为一个日益严重的公共卫生挑战,也是成年人群中预防和治疗的优先事项,在过去二十年中,肥胖的患病率显著增加[1-3]。肥胖不仅对健康构成严重威胁,还与其他疾病共病,包括精神疾病[4-11]。确定肥胖最常见的方法之一是测量BMI(身体质量指数),以千克为单位的质量除以米的平方[12-13]。肥胖是双相情感障碍(BAD)患者的常见疾病,并与体重增加导致的生活质量显著受损有关[14-16]。它与BAD患者的疾病结果显著相关[17]。与平均体重的人相比,肥胖者一生中经历的抑郁和躁狂发作次数更多,其临床表现症状强度更高,抑郁残留更频繁[18-22]。肥胖与几个重要的心理和社会因素有关,如生活质量较差,缺乏社会功能、更大的不满感、自卑感和较差的整体身体健康[23-26]。目前的文化规范鼓励苗条身材的理想。当代西方文化认为肥胖者要对自己的状态负责,他们提倡对生活的许多方面负责的态度,包括控制体重和外表。由于这些文化假设,肥胖者经常被描述为“懒惰、丑陋和愚蠢”。因此,肥胖者在职业和私人生活中经常受到歧视和污名化。考虑到这些负面归因,肥胖者患各种疾病的风险增加是合乎逻辑的,包括严重的精神障碍和自杀行为[20-27]。自杀行为被定义为包含广泛的语义范围:从自杀意念、言语、计划、意图和自残到自杀未遂及其执行,即自杀。自杀行为是一种基于生物学、环境、发育和学习因素的病因复杂现象[28-31]。BAD的自杀风险很高,约为15%。自杀行为是导致死亡的第三大常见原因,也是15至24岁年龄组的第三主要死亡原因[21,24,32-35]。在对具有全国代表性的大型样本组(超过40000人)进行的类似研究中,Carpenter等人发现肥胖和抑郁之间存在性别依赖性相关性。在一组肥胖女性中,37%的人在过去一年中经历过严重的抑郁发作,20%的人有过自杀念头,23%的人曾试图自杀。在平均体重的女性中,没有发现与抑郁或自杀有关[7]。女性专注于自己的体重和身材。她们渴望理想的身体,并根据自己的外表来评估自己[36-39]。对真实身体外观的感知本身受到身体“理想”外观和社会刻板印象的影响[37,40,41]。身体被看作是自我的反映。身体形象是人们体验自己的一种方式,但同样重要的是,也是他们相信他人看到自己的方式。身体形象在一生中不断变化,这取决于客观和主观的影响(成长、创伤、疼痛、手术)。文化环境及其对什么是可取的和有吸引力的共同定义在身体形象的发展中发挥着重要作用。一个人的身体形象包括他们对文化标准的感知,对他们与标准一致的衡量标准的评估,以及对文化群体成员身份及其地位的重要性的感知[40-42]…
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引用次数: 2
The differences in Quality of Life between the Heroin Addicts treated in Methadone Program and Addicts treated in the Frame of Therapeutic Community Program 美沙酮治疗组与社区治疗组之生活品质差异
Pub Date : 2017-06-26 DOI: 10.20471/APR.2017.53.01.02
Danijel Bevanda, I. Tomić, M. Bevanda, S. Skočibušić, Nikolina Palameta, M. Martinac
IntroductionThe addiction to heroin is a severe disorder and its treatment represents a complicated, long-lasting process, which includes a series of various interventions which have to be constantly adjusted to patients' present state and his abilities to accept the therapy. The addiction is very resistant to treatment and if the program is not at the same time, enough influential and persistent, but also acceptable to the addict to stick to it for months or even years, the expected results will not be achieved. Retention to the program, abstinence from the illicit drugs, reduction of illegal activities and improving the aspects of socially acceptable behaviour are the best indicators of therapeutic efforts [1-5].Already thirty years ago, the most of western-European countries and USA, Canada and Australia have accepted the use of methadone as a recognized method for treatment of opiate addicts and a useful tool in the frame of 'harm-reduction' approach for helping the not-motivated or incurable heroin addicts. Methadone enables those patients to stop or significantly reduce taking heroin. Although methadone does not create the feeling of euphoria similar to the effect of heroin, it replaces the biological lack of endorphins at the opioid receptors in brain and, with its help, the patient can achieve a psychophysical balance and control the pathological addict's craving. The use of methadone is the best way to attract the addicts from the street to the process of treatment and, if it is well organized and spread, can ultimately direct many addicts towards the programs that would help them in stabilizing the permanent abstinence [1-5].In the evaluation study carried out by the American National Institute for Drugs (NIDA) it has been found that the substitution therapy reduces users' heroin intake for 70%, and their criminal activity by 57 %. [6]. It has also been reported that the countries which use methadone attract up to 75% of opiate addicts to their programs, while those that do not use it, achieve less than 20 %, making the mortality of addicts due to overdose very high. A large number of addicts included in substitution programs function better socially, i.e. better fulfill their duties at the workplace and in families and display significantly less dealings with criminal activities, particularly with selling drugs, thus reducing the risk of initial drug abuse among the healthy population. Application of methadone improves the physical and mental health of the addict, his life gets longer and the risk for early sudden death is reduced. By using methadone, physical and mental health of addicts is improved, their lifespan prolonged i.e. the risk of sudden death is reduced. The addicts in substitution programs are less dangerous concerning the spread of HIV infection, hepatitis and encouraging others to take drugs. The use of methadone in pregnancy is absolutely indicated: it reduces the risk of unwanted pregnancy termination and the risk of
引言海洛因成瘾是一种严重的疾病,其治疗是一个复杂而持久的过程,包括一系列不同的干预措施,这些干预措施必须根据患者的现状和接受治疗的能力不断调整。成瘾是非常抗拒治疗的,如果该项目在同一时间没有足够的影响力和持久性,而且成瘾者也可以接受,坚持几个月甚至几年,那么预期的结果就不会实现。保留该计划、戒除非法药物、减少非法活动和改善社会可接受行为是治疗努力的最佳指标[1-5]。早在30年前,大多数西欧国家以及美国、加拿大和澳大利亚就已经接受使用美沙酮作为治疗阿片成瘾者的公认方法,并将其作为“减少伤害”方法框架中的一个有用工具,帮助那些没有动机或无法治愈的海洛因成瘾者。美沙酮使这些患者能够停止或显著减少吸食海洛因。尽管美沙酮不会产生类似海洛因的欣快感,但它取代了大脑中阿片受体生物上缺乏内啡肽的现象,在它的帮助下,患者可以实现身心平衡,控制病理性瘾君子的渴望。美沙酮的使用是吸引街头瘾君子参与治疗过程的最佳方式,如果组织和传播得当,最终可以引导许多瘾君子参与有助于他们稳定永久禁欲的项目[1-5]。美国国家毒品研究所(NIDA)进行的评估研究发现,替代疗法使使用者的海洛因摄入量减少了70%,犯罪活动减少了57%。[6] 。据报道,使用美沙酮的国家吸引了高达75%的阿片类药物成瘾者参加其项目,而不使用的国家则不到20%,这使得吸毒过量成瘾者的死亡率非常高。被纳入替代计划的大量吸毒者在社会上表现得更好,即更好地履行工作场所和家庭中的职责,与犯罪活动,特别是与销售毒品的交易明显减少,从而降低了健康人群最初滥用毒品的风险。美沙酮的应用改善了瘾君子的身心健康,延长了他的寿命,降低了早期猝死的风险。使用美沙酮可以改善瘾君子的身心健康,延长他们的寿命,即降低猝死的风险。替代计划中的瘾君子在艾滋病毒感染、肝炎和鼓励他人吸毒方面的危险性较小。在怀孕期间使用美沙酮是绝对必要的:它可以降低意外终止妊娠的风险和损害胎儿的风险。[1] 。在治疗社区(TZ)的框架下,成瘾的“无药物”寄宿治疗始于60年代初,作为现有传统项目的替代方案,以自助和互助的形式开始。TZ的平均停留时间不同(18-60个月)。工作人员主要由以前的瘾君子组成,而其他工作人员则由心理健康领域的医疗专业人员、心理学家、叛逃学家、教师等组成。留在TZ的目的是改变全球的生活方式,包括戒除非法物质、消除反社会活动、收集求职技能以及发展亲社会的努力和价值观。在TZ中,解毒是进入治疗的条件,而不是治疗的目标。大多数进入TZ的患者已经有多次药物滥用史,心理社会功能严重紊乱,因此生活质量显著降低…
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引用次数: 1
Zoophilia as an Early Sign of Psychosis 动物癖是精神病的早期征兆
Pub Date : 2017-06-26 DOI: 10.20471/APR.2017.53.01.03
Vinka Lesandric, I. Orlović, V. Peitl, D. Karlovic
IntroductionZoophilia is a disorder of sexual preference that is characterised by sexual fantasies or behaviours that include animals [1]. Although sexual contact between a man and an animal has been described since biblical times, zoophilia as a mental disorder is first classified in the third edition of the Diagnostic and statistic manual for mental research (DSM-III) [2]. In the last edition of DSM5 5 is classified under the category "Other specified paraphilic disorder". This category is applied for clinical pictures where dominant symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, but do not meet the full criteria for any of the disorders in the paraphilic disorders diagnostic class. With the above mentioned, it is important to meet the time criteria of at least six months of recurrent and intense sexual arousal involving animals. Therefore, paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily require clinical intervention until it causes distress or impairment to the individual or risk of harm to others [3]. According to the other most acknowledged diagnostic guidelines, zoophilia is classified into "other disorders of sexual preference" [4]. In the recent literature there are several articles where authors tried to classify zoophilia to help its easier diagnosis and treatment. For the sake of easier diagnosis, Aggrawal and associates, in 2011, have offered a classification of zoophilia in ten categories, which among the others include sexual fantasies about animals, occasional sexual relations with animals and exclusive sexual relations with animals [5].When talking about the etiology and patophisiology of paraphilia, all the information leading to now suggest an influence of psychosocial and neurobiological factors for the formation of deviant sexual behaviour. Psychological factors which are though to be most important are family violence, dysfunctional family relations, and sexual abuse in childhood. When talking about the neurobiological side, endocrine function in pedophilia research has shown an elevated response of luteinisic hormone (LH) to stimulation of the luteinisic releasing hormone (LRH) or gonadotropin releasing hormone (GRH) [6], which could also be present in zoophilia, but has not been decisively confirmed when taken in consideration a relatively rare incidence of this paraphilia. Furthermore, Casanova and associates have come to a closer approach to the patoanatomic basis of zoophilia, by a representation of two psychiatric patients with zoophilia, where in both of the patients' post mortem had found atrophy of hippocampal pyramidal cells. The first case was a man that suffered from hebephrenic schizophrenia, and the second case was a man that suffered from a bipolar affective disorder and chronic alcoholism. In both cases alongside zoophilia, records show incid
简介恋物癖是一种性偏好障碍,其特征是包括动物在内的性幻想或行为[1]。尽管自圣经时代以来,人们就对人与动物之间的性接触进行了描述,但恋童癖作为一种精神障碍首次被归类于《精神研究诊断与统计手册》(DSM-III)的第三版[2]。在DSM5的最新版本中,5被归类为“其他特定的味觉障碍”。这一类别适用于临床图片,其中主要症状在社会、职业或其他重要功能领域引起临床显著的痛苦或损害,但不符合生殖道疾病诊断类别中任何疾病的全部标准。如上所述,重要的是要满足至少六个月的动物反复强烈性唤起的时间标准。因此,味觉障碍是患味觉障碍的必要条件,但不是充分条件,味觉障碍本身不一定需要临床干预,直到它对个人造成痛苦或损害或对他人造成伤害的风险[3]。根据其他公认的诊断指南,嗜动物症被归类为“其他性偏好障碍”[4]。在最近的文献中,有几篇文章作者试图对嗜动物症进行分类,以帮助其更容易诊断和治疗。为了便于诊断,Aggrawal及其同事在2011年将恋童癖分为十类,其中包括对动物的性幻想、偶尔与动物发生性关系和与动物发生排他性性关系[5],所有导致现在的信息都表明,心理社会和神经生物学因素对越轨性行为的形成有影响。最重要的心理因素是家庭暴力、家庭关系失调和儿童时期的性虐待。当谈到神经生物学方面时,恋童癖研究中的内分泌功能显示,黄体生成素(LH)对黄体生成素释放激素(LRH)或促性腺激素释放激素(GRH)刺激的反应升高[6],这也可能存在于恋童癖中,但考虑到这种副生殖器的相对罕见的发生率,尚未得到决定性的证实。此外,Casanova及其同事通过对两名患有恋童癖的精神病患者的描述,更接近于恋童症的太平洋原子基础,在这两名患者的尸检中,他们都发现了海马锥体细胞的萎缩。第一个病例是一名患有肝源性精神分裂症的男子,第二个病例是患有双相情感障碍和慢性酒精中毒的男子。在这两种情况下,除了恋童癖外,记录还显示了其他副癖的发生率[7]。最近的一些研究表明,男性、智力迟钝、社交技能差和教育水平较低的人的恋童癖发生率较高,农村地区的人,尤其是从事动物工作的人,恋童癖的发病率较高[8]。然而,也有相反的发现,比如一项对82名男性和11名女性样本的互联网研究,这导致了受教育程度较高、社会功能正常的人更常见的恋童癖[9]。根据Abel及其同事对561名接受性变态反应治疗的男性进行的一项研究,发现某些恋童癖患者同时表现出其他性变态反应,同时,除了性偏好障碍及其表现之外,其他精神疾病尚未得到研究[10]。嗜动物症和其他精神疾病。一些研究试图回答精神病患者中存在多少嗜动物症的问题…
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引用次数: 12
期刊
Alcoholism and psychiatry research
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