No description available.

Background: The role of the norepinephrine transporter (NET) has received increased focus in recent studies on the pathogenesis of attention-deficit/hyperactivity disorder (ADHD). The predictive value for pharmacological treatment and its link to other health or social limitations has been little-studied. This follow-up research on adult patients with ADHD aimed to explore whether the therapy response and health and social impairments depend on baseline individual NET availability. Methods: Data were collected from 10 patients on personal, family and professional situations, mental and physical health and treatments received after baseline via online and telephone surveys and were compared to baseline data to evaluate treatment-related changes. Results: The majority of our ADHD patients did not show therapy responses but showed improvements due to pharmacological treatment. There was no evidence of relationships between pre-treatment NET availability and therapy response or health/social limitations. Conclusions: Pharmacological monotherapy was insufficient to promote symptom remission, especially for participants with extreme insufficiency in NET availability, but improved outcomes in academic and social functioning. Psychotherapy should be considered as an add-on to the standard treatment approach due to its positive outcome in reducing social limitations. The prognostic value of individual NET availability in predicting the response to therapy needs further studies with large sample sizes

Bakgrund: Psykisk ohälsa hos befolkningen har ökat och personer med psykisk och fysisk samsjuklighet har en ökad risk att dö upp till 20 år tidigare på grund av fysiska sjukdomar. Det förekommer stigmatiserande attityder mot dessa patienter inom vården och på grund av sin psykiska ohälsa blir de bemötta annorlunda och riskerar att bli utan god somatisk vård. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda patienter med psykisk ohälsa inom somatisk vård. Metod: En allmän litteraturstudie med beskrivande syntes av 12 kvalitativa artiklar. Resultat: 3 teman och 7 subteman framkom. Första temat beskriver känslor som uppstod i mötet med patienter, andra temat lyfter kompetens av att vårda patienter med psykisk ohälsa och tredje temat hur vårdmiljön påverkade möjligheten till god vård för dessa patienter. Slutsats: Sjuksköterskor upplevde svårigheter att utföra god vård till patienter med psykisk ohälsa under samtliga teman. Sjuksköterskor hade en önskan att utveckla sin kompetens för att kunna hjälpa dessa patienter. Trots orsaker på arbetsplatsen som sjuksköterskor själva har svårt att ändra på, försökte sjuksköterskor anpassa sig och tillgodose de behov som patienter med psykisk ohälsa hade. / Background: Population with mental illness has increased and people with mental and physical comorbidity have an increased risk of dying up to 20 years earlier due to physical diseases. There are stigmatizing attitudes towards these patients in health care and because of their mental illness they are treated differently and risk being without good somatic care. Aim: To describe nurses' experiences of caring for patients with mental illness in somatic care. Method: General literature review with descriptive synthesis of 12 qualitative articles. Results: 3 themes and 7 subthemes emerged. First theme describes feelings that arose in the meeting with patients, second theme highlights the competence of caring for patients with mental illness and the third theme how care environment affected the possibility of good care for these patients. Conclusion: Nurses experienced difficulties in providing good care to patients with mental illness under all themes. Nurses had a desire to develop their skills to be able to help these patients. Despite causes in the workplace that nurses themselves found difficult to change, nurses tried to adapt and meet the needs of patients with mental illness.

No description available.

No description available.

Bristande samverkan avseende det dubbla huvudmannaskapet mellan kommun och region medför att individer med substansberoende riskerar att falla mellan stolarna och de löper därmed en högre risk att hamna utanför samhället. Vidare är samsjuklighet mellan substansberoende och ADHD vanligt. Självmedicinering kan ses som en förklaring till detta samband och som en alternativ handlingsstrategi bortom insatser från olika samhällsaktörer. Det är därför intressant att undersöka hur vuxna personer som upplever ADHD-symptom diskuterar självmedicinering på ett diskussionsforum. Självmedicineringshypotesen, teorin om medieanvändning och tillfredsställelse samt social identitetsmodell för avindividualiseringseffekter bidrar med en tolknings- och förståelseram för analysen av empirin. Netnografi och tematisk analys används för att strukturera och bearbeta materialet. Studien synliggör hur en eftersträvan att fungera normalt och drogliberala attityder beskrivs som vanliga motiv bakom valet att självmedicinera. Bland de fördelar som nämns gällande självmedicinering är ett exempel lindring av ADHD symptom, medan en av de nackdelar som diskuteras är att stämplas som missbrukare av familj samt av hälso- och sjukvården. Användningen av ett diskussionsforum är av betydelse för forumanvändarna då de vänder sig dit både för bland annat informationssökande och för en känsla av gruppsamhörighet - något som har betydelse för beslutet att självmedicinera.

<p>Hronične inflamatorne bolesti disajnih organa su&nbsp;jedan od vodećih uzroka morbiditeta i mortaliteta&nbsp;&scaron;irom sveta. I pored stalnog napretka u naučnim&nbsp;istraživanjima, u otkrivanju molekularnih i ćelijskihmehanizama koji doprinose progresiji bolesti, uvođenju novih prognostičkih biomarkera, novim&nbsp;metodama detektovanja infektivnih uzročnika,&nbsp;primeni novih moćnih bronhodilatatornih,&nbsp;antiniflamatornih i antiinfektivnih lekova, hronične&nbsp;plućne bolesti i danas u dvadeset prvom veku beleže&nbsp;stalan porast broja obolelih i umrlih. Prema savremenom tumačenju HOBP je&nbsp; heterogena bolest koja je udružena sa brojnim komorbiditetima i&nbsp;sistemskim manifestacijama. Zajednički faktori rizika&nbsp;su osnova za javljanje udruženih hroničnih bolesti. Komorbiditeti i akutne egzacerbacije doprinose&nbsp;ukupnoj težini bolesti . S obzirom da se HOBP&nbsp;manifestuje i izvan pluća kod svakog pacijenta je&nbsp;potrebno proceniti postojanje sistemskih&nbsp;manifestacija&nbsp; i tragati za komorbiditetima. U reviziji&nbsp;&bdquo;Globalne strategije za dijagnozu, lečenje i prevenciju hronične opstruktivne bolesti pluća H GOLD&ldquo;&nbsp; iz 2011. godine navedene sledeće pridružene bolesti za&nbsp;kojima je potrebno aktivno tragati: kardiovaskularne&nbsp;bolesti, disfunkcija skeletnih mi&scaron;ića, metabolički&nbsp;sindrom, osteoporoza, depresija i karcinom pluća.&nbsp;Bronhiektazije sepredstavljaju hronično oboljenje&nbsp;pluća koje se karakteri&scaron;e abnormalnim pro&scaron;irenjem&nbsp;lumena bronha koje je uzrokovano slabljenjem ili&nbsp;destrukcijom mi&scaron;ićnih i elastičnih komponenti&nbsp;bronhijalnog zida, smanjenim klirensom mukusa i&nbsp;čestim infekcijama respiratornog trakta. Bronhiektazije se nekim svojim&nbsp; kliničkim&nbsp;karakteristikama preklapaju&nbsp; sa hroničnom opstruktivnom bolesti pluća. Metabolički sindrom&nbsp;predstavlja skup metaboličkih poremećaja koji&nbsp;povećavaju rizik za razvoj kardiovaskularnih bolesti i tipa 2 &scaron;ećerne bolesti. Za na&scaron;e istraživanje smo&nbsp;koristili definiciju NCEPHATPIII prema kojoj se metabolički sindrom zasniva na prisustvu tri od pet&nbsp;komponenti: Abdominalna gojaznost (obim struka&nbsp;preko 102 cm za&nbsp; mu&scaron;karce i preko 88 cm za žene),&nbsp;povi&scaron;ene vrednosti triglicerida na&scaron;te preko 1,7 mmol/l ili od ranije lečen poremećaj, snižen nivo HDL&nbsp;holesterola manje od 1,03 mmol/l za mu&scaron;karce i&nbsp;manje od 1,29 mmol/l za žene ili već lečen&nbsp;poremećaj, povi&scaron;en sistolni krvni pritisak preko 130 mmHg i/ili dijastolni preko 85 mmHg ili već lečena&nbsp;hipertenzija, povi&scaron;en nivo glukoze na&scaron;te preko 5,6 mmol/l ili već postojeći tip 2 &scaron;ećerne bolesti.&nbsp;Istraživenje je sprovedeno u Institutu za plućne&nbsp;bolesti Vojvodine u Sremskoj Kamenici. Cilj je bio&nbsp;da se utvrdi učestalost metaboličkog sindroma i&nbsp;komponenti među bolesnicima sa HOBP i&nbsp;bronhiektazijama. Sledeći cilj je bio da analizira&nbsp;i uporedi&nbsp; zastupljenosti metaboličkog sindroma i pojedinih komponenti među ispitivanim grupama u&nbsp;odnosu na pol, starost bolesnika i dužinu lečenja&nbsp;HOBP. Bilo je uključeno ukupno 193 ispitanika. Od&nbsp;ovog broja 163 su činili bolesnici od HOBP i&nbsp;bronhiektazija&nbsp; koji su bili podeljeni u tri grupe:&nbsp;pacijenti oboleli od hronične opstruktivne bolesti&nbsp;pluća (n=55, grupa 1), pacijenti oboleli od bronhiektazija (n=50, grupa 2) i pacijenti sa&nbsp;udruženom hroničnom opstruktivnom bolesti pluća i&nbsp;bronhiektazijama (n=58, grupa 3). Kontrolna grupa,&nbsp;koja je označena kao grupa 4, formirana je od 30&nbsp;ispitanika bez bronhiektazija i hronične opstruktivne bolesti pluća, tako da je ukupan broj ispitanika u&nbsp;istraživanju bio 193. Učestalost metaboličkog&nbsp;sindroma prema kriterijumuma NCEP/ATP III kod&nbsp;bolesnika hroničnim bolestima respiratornog sistema&nbsp;(hroničnom opstruktivnom bolesti pluća,&nbsp;bronhiektazijama i udružena ova dva oboljenja) je&nbsp;iznosila je kod 37,3 % . Metabolički sindrom je bio&nbsp;učestaliji kod ispitanika sa hroničnim opstruktivnom<br />bolesti pluća i/ili bronhiektazijama u odnosu na&nbsp;ispitanike iz kontrolne grupe bez&nbsp; hroničnih bolesti&nbsp;respiratornog trakta. Kod bolesnika sa hroničnom&nbsp;opstruktivnom bolesti pluća dokazano je prisustvo&nbsp;metaboličkog sindroma kod 38,2%&nbsp; ispitanika, kod&nbsp;bolesnika sa bronhiektazijama kod 54% ispitanika i&nbsp;IV kod pacijenata sa udruženom hroničnom&nbsp;opstruktivnom bolesti pluća i bronhiektazijama kod&nbsp;36,2% ispitanika. Prosečan broj komponenti&nbsp;metaboličkog sindroma kod bolesnika sa hroničnom&nbsp;opstruktivnom bolesti pluća je iznosio 2,18, kod&nbsp;bolesnika sa bronhiektazijama je bio 2,56, a kod&nbsp;bolesnika sa udružena ova dva oboljenja 2,1.<br />Komponente metaboličkog sindroma nisu učestalije i&nbsp;nisu statistički vi&scaron;e kod bolesnika sa udruženom&nbsp;hroničnom opstruktivnom bolesti pluća i&nbsp;bronhiektazijama u odnosu na obolele sa HOBP i&nbsp;bronhiektazijama kao samostalnim oboljenjima.<br />Razlika u pojedinačnim vrednostima komoponenti&nbsp;metaboličkog sindroma i učestalosti pojedinih&nbsp;komponenti među posmatranim grupama bolesnika sa<br />hroničnim plućnim bolestima nije statistički značajna.&nbsp;Učestalost metaboličkog sindroma kod bolesnika sa&nbsp;hroničnim bolestima respiratornog sistema nije u vezi sa polom i ne zavisi od starosti ispitanika. Nije&nbsp;dokazano da je metabolički sindrom učestaliji kod&nbsp;mu&scaron;karaca i i nije dokazano da je učestaliji kod&nbsp;ispitanika koji imaju vi&scaron;e od &scaron;esdeset i pet godina&nbsp;u odnosu na mlađe bolesnike među ispitivanim.&nbsp;Učestalost metaboličkog sindroma kod ispitanika sa&nbsp;hroničnom opstruktivnom bolesti pluća ne zavisi od&nbsp;dužine lečenja hronične opstruktivne bolesti pluća.&nbsp;Dokazano je da učestalost&nbsp; metaboličkog sindoma&nbsp;nije veća kod bolesnika kojima je dijagnoza bolesti postavljena pre vi&scaron;e od pet godina i koji se od HOBP&nbsp;leče duže od pet godina. Na osnovu rezultata koje&nbsp;smo dobili u na&scaron;em istraživanju zaključili smo da&nbsp;hronične plućne bolesti, bronhiektazije i hronična&nbsp;opstruktivna bolest pluća, predstavljaju stanja sa povi&scaron;enim kardiometaboličkim rizikom.</p><p>&nbsp;</p> / <p>Chronic inflammatory diseases of the respiratory&nbsp;organs are one of the leading morbidity and&nbsp;mortality causes all over the world. Despite the&nbsp;steady advance in scientific research, discovery&nbsp;of&nbsp; the disease-progression-contributing molecular<br />and cellular mechanisms, introduction of novel&nbsp;prognostic biomarkers, new detection methods of&nbsp;infectious agents, application of&nbsp; new, potent&nbsp;bronchodilation, anti-inflammatory and anti-infectious drugs,&nbsp; a constant&nbsp; increase in&nbsp; the&nbsp;number of the affected and deceased from chronic&nbsp;pulmonary diseases has still been permanently<br />evidenced in the 21st century. In a modern&nbsp;concept, the chronic obstructive pulmonary<br />disease (COPD) is understood as a heterogenous&nbsp;disorder associated with numerous comorbidities&nbsp;and systemic manifestations. Common risk factors&nbsp;represent the basis for concomitant chronic&nbsp;diseases to develop. Comorbidities and acute&nbsp;exacerbations contribute to the overall disease&nbsp;severity. As a COPD may develop extrapulmonary manifestations as well, each&nbsp;patient should be evaluated for systemic&nbsp;manifestations and comorbidities. The 2011&nbsp;update of the &bdquo;Global Strategy for Chronic&nbsp;Obstructive Lung Disease Diagnosis,&nbsp;Management, and Prevention &ndash;GOLD&rdquo; lists the&nbsp;following comorbidities to be actively searched&nbsp;for: cardiovascular diseases, skeletal muscle<br />dysfunction, metabolic syndrome, osteoporosis,&nbsp;depression, and lung cancer. Bronchiectases&nbsp;represent a chronic lung disorder marked by&nbsp;VII excessively dilated bronchial lumen&nbsp; induced by&nbsp;weakened or destructed muscular and elastic&nbsp;components of the bronchial wall, reduced mucus&nbsp;clearance, and recurrent respiratory infections.&nbsp;Bronchiectases and COPD have some clinical&nbsp;features in common. The metabolic syndrome is a&nbsp;group of metabolic disorders which increase the&nbsp;risk of&nbsp; cardiovascular diseases and type 2&nbsp;diabetes. In our investigation, we utilized the&nbsp;NCEP HATPIII definition of the metabolic&nbsp;syndrome based on the presence of three of five&nbsp;components: abdominal obesity (&gt; 102 cm and &gt;<br />88 cm waist&nbsp; measure for males and females&nbsp;respectively), elevated (&gt;1.7 mmol/l) triglyceride&nbsp;levels on an empty stomach, or a former history of&nbsp;the disorder treatment, reduced&nbsp; HDL cholesterol&nbsp;(&lt; 1.03 mmol/l and &lt;1.29 mmol/l for males and&nbsp;females respectively), or a former history of the&nbsp;disorder treatment, elevated systolic blood<br />pressure of &gt;130 mmHg and/or diastolic blood&nbsp;pressure of &gt; 85 mmHg, or a former history of&nbsp;treated hypertension, elevated glucose levels&nbsp; (&gt;5.6 mmol/l), or already existing type 2 diabetes&nbsp;mellitus. The investigation has been carried out in<br />the Institute for Pulmonary Diseases of&nbsp;Vojvodina, Sremska Kamenica, aimed at 1)<br />establishing the frequency of the metabolic&nbsp;syndrome and its components among the patients&nbsp;with COPD and bronchiectases; 2) analyze and&nbsp;compare the frequency of metabolic syndrome&nbsp;and its components in the examined groups related&nbsp;to the patients&rsquo; sex, age, and COPD treatment&nbsp;length. The study included 193 subjects, 163 of&nbsp;whom suffered from COPD and bronchiectases,&nbsp;classified into three groups: COPD patients (n=55,&nbsp;Group 1), patients with bronchiectases (n=50,&nbsp;Group 2), and patients with concurrent COPD and&nbsp;bronchiectases (n=58, Group 3). The control&nbsp;group, designated as Group 4, included 30&nbsp;subjects&nbsp; free of bronchiectases and COPD, so the&nbsp;total of 193 subjects were included in the&nbsp;investigation. The NCEP/ATP III criteria<br />established metabolic syndrome frequency among&nbsp;the patients with chronic respiratory diseases&nbsp;(COPD, bronchiectases, and concomitant COPD&nbsp;and bronchiectases) amounted to 37.3 % . The&nbsp;metabolic syndrome was more frequent in the&nbsp;patients with COPD and/or bronchiectases than in&nbsp;the control group patients free of any chronic&nbsp;respiratory disease. The metabolic syndrome was&nbsp;VIII confirmed in 38.2% of COPD patients, 54% of the&nbsp;patients with bronchiectases, and in 36.2% of the<br />patients with&nbsp; concomitant COPD and&nbsp;bronchiectases. The mean number of the<br />metabolic syndrome components was&nbsp; 2.18 in&nbsp;COPD patients,&nbsp;&nbsp; 2.56 in patients with<br />bronchiectases, and 2.1 in patients with&nbsp;concomitant COPD and bronchiectases. The<br />metabolic syndrome components were neither&nbsp;more frequent, nor statistically higher in the&nbsp;patients with concomitant COPD and&nbsp;bronchiectases as compared to the patients with a&nbsp;single presence of any of the two diseases. The&nbsp;difference in the single values of the metabolic&nbsp;syndrome components and the frequency of&nbsp;certain components in the examined groups of the&nbsp;patients with chronic pulmonary diseases was not&nbsp;statistically significant. Among the patients with&nbsp;chronic respiratory diseases, no correlation was&nbsp;observed between the metabolic syndrome&nbsp;frequency and the patients&rsquo; sex or age. The&nbsp;metabolic syndrome was not confirmed to be&nbsp;more frequent in males, or in&nbsp;&nbsp; &gt;65 yr old patients,&nbsp;as compared to younger patients. Among COPD<br />patients, no correlation was registered between the&nbsp;metabolic syndrome frequency and&nbsp;&nbsp; COPD&nbsp;treatment duration. It was confirmed that the&nbsp;metabolic syndrome frequency was not higher in&nbsp;the patients with &lt;5Hyear long COPD treatment<br />than in those treated for COPD longer. On the&nbsp;basis of the results obtained in our investigation,&nbsp;we conclude that chronic respiratory diseases,&nbsp;COPD and &nbsp;bronchiectases, are the conditions with&nbsp;a higher cardiometobolic risk.</p>

<p>UVOD: Moždani udar spada u grupu masovnih nezaraznih bolesti, koje se smatraju najče&scaron;ćim oboljenjima savremenog čoveka. On predstavlja jedan od najče&scaron;ćih uzroka mortaliteta i invaliditeta u savremenom svetu. Među brojnim pratećim komplikacijama moždanog udara, navode se psihički poremećaji: depresija, anksioznost i psihotični poremećaji. Utvrđivanje povezanosti moždanog udara sa psihičkim poremećajima, kao i mehanizma njihovog nastanka predstavlja značajan doprinos boljem razumevanju ovog veoma čestog oboljenja, a njihov rani tretman omogućio bi brži i potpuniji oporavak nakon moždanog udara. CILJ: Utvrditi karakteristike psihičkog funkcionisanja osoba nakon ishemičnog moždanog udara, utvrditi uticaj lokalizacije lezije na nastanak određenih psihičkih poremećaja nakon moždanog udara, utvrditi uticaj vaskularnog statusa na nastanak psihičkih poremećaja, te utvrditi korelaciju između psihičkih komplikacija moždanog udara i brzine i stepena oporavka op&scaron;te životne aktivnosti. MATERIJAL I METODE: Istraživanje je izvedeno kao prospektivna studija, obuhvatilo je 101 pacijenta oba pola obolelih od moždanog udara, koji su hospitalno lečeni na Klinici za neurologiju u Novom Sadu. Svim pacijentima je uzeta anamneza o toku bolesti, faktorima rizika za moždani udar, kao i laboratorijska dijagnostika. Svim pacijentima načinjena je kompjuterizovana tomografija (CT) mozga (ili magnetna rezonanca - MRI mozga), ultrazvučni pregled karotidnih arterija, vertebrobazilarnih i krvnih sudova Willisovog poligona. Stepen neurolo&scaron;kog deficita i praćenje funkcionalnog oporavka u akutnoj fazi i nakon 3 meseca vr&scaron;eno je primenom Skale Moždanog Udara Nacionalnog Instituta za Zdravlje (NIHSS), Rankinove skale i Bartelovog indeksa. Svim pacijentima je načinjena eksploracija psihičkog statusa u akutnoj fazi bolesti primenom Bekove Skale Depresije 2 (BDI-2), Skale procene anksioznosti kao stanja i odlike (STAI), Skale pozitivnih i negativnih sindroma (PANSS) i Kornelovog regrutnog indeksa (CSI). Kontrolno testiranje gore navedenim testovima obavljeno je nakon 3 meseca. Od statističkih metoda kori&scaron;ćena je deskriptivna statistika: tabelarni prikazi učestalosti i procentualna izraženost kod neparametrijski (nominalno ili ordinarno) organizovanih varijabli. Za ukr&scaron;ten prikaz dve varijable kori&scaron;ćene su tabele kontingencije. Takođe su kori&scaron;ćene mere centralne tendencije (aritmetička sredina) i mere disperzije (standardna devijacija) kod parametrijski korektno uređenih varijabli. Pored toga, kori&scaron;ćen je Hi-kvadrat test za utvrđivanje razlika između grupa za varijable nominalnog nivoa merenja, Kramerovo V za utvrđivanje povezanosti između nominalnog nivoa merenja, Pirsonov koeficijent korelacije r, za utvrđivanje povezanosti između varijabli intervalnog nivoa merenja, te analiza varijanse (ANOVA) za utvrđivanje značajnosti razlika između aritmetičkih sredina vi&scaron;e grupa. REZULTATI: U ispitivanje je uključen 101 pacijent, 65.3% mu&scaron;kog pola, 34.7% ženskog pola. Prosečna starost bila je 60.69 godina (medijana=62.00, standardna devijacija =10.828, statistička gre&scaron;ka=1.077). 38.6% je imalo lokalizaciju u desnoj hemisferi velikog mozga, 34.7% u levoj hemisferi, 4% u cerebelumu, 11.9% u moždanom stablu, dok je 10.9% imalo vi&scaron;estruku lokalizaciju infarkta. 39.6% je imalo teritorijalni infarkt, a 59.4% lakunarni infarkt. Distribucija faktora rizika za moždani udar bila je uobičajena za podneblje na kojem je vr&scaron;eno istraživanje. 26.7% je imalo uredan nalaz na karotidnim krvnim sudovima, 26.7% je imalo difuznu ateromatozu, 27.7% je imalo stenozu ACI &lt;70% , dok je 18.8% pacijenata imalo stenozu ACI&gt;70%. U odnosu na nalaz u VB slivu, 52.5% je imalo uredan nalaz, a 47.5% patolo&scaron;ki nalaz (stenozu i difuznu ateromatozu). 54.5% pacijenata je imalo uredan nalaz na arterijama Willisovog poligona, a 45.5% je imalo patolo&scaron;ki nalaz (stenozu i difuznu ateromatozu). 5.9% je imalo depresivni poremećaj, 29.7% anksiozni poremećaj, 9.9% neurotski poremećaj i 2% psihotični poremećaj. U odnosu na pol, depresivni poremećaj javlja kod 3% mu&scaron;karaca i 11.4% žena, anksiozni kod 25.8% mu&scaron;karaca i 37.1% žena, neurotski kod 7.6% mu&scaron;karaca i 14.3% žena i psihotični kod 3% mu&scaron;karaca, dok kod žena nije zabeležen. U odnosu na životno doba, kod mlađih od 45 godina depresija nije bila prisutna, anksioznih je bilo 30%, 10% psihotičnih, dok neurotičnih nije bilo. U grupi 46-65 godina depresivnih je bilo 6.9%, anksioznih 22.4%, neurotičnih 12.1%, a psihotičnih 1.7%. U grupi starijih od 65 godina, depresivnih je bilo 6.1%, anksioznih 42.4%, neurotičnih 9.1%, dok psihotičnih nije bilo. Distribucija odgfovora dobijenih na BDI-2 skali ukazivala je na veću učestalost depresivnog poremećaja kod lezija u levoj hemisferi velikog mozga. Distribucija odgovora dobijenih primenom STAI ukazivala je na veću učestalost anksioznog poremećaja kod lezija desne hemisfere. Distribucija odgovora dobijenih primenom CSI ukazivala je na veću učestalost neurotskog poremećaja kod vi&scaron;estrukih lezija. Distribucija odgovora dobijenih primenom PANSS ukazivala je na veću učestalost psihotičnog poremećaja kod lezija desne hemisfere. Upoređivanje lezije na karotidama i psihičkih poremećaja pokazalo je na progresivni porast učestalosti psihičkih poremećaja sa težinom lezije na karotidnim krvnim sudovima, kao i na potpuno odsustvo psihičkih poremećaja kod osoba koje su imale uredan nalaz na karotidama. Praćenje uticaja psihičkih poremećaja (sumarno i pojedinačno) na funkcionalni oporavak pacijenata nakon moždanog udara, nije pokazalo statistički značajan uticaj. Zabeleženo je statistički značajno udruženo pojavljivanje depresivnog i anksioznog, depresivnog i neurotskog i anksioznog i neurotskog poremećaja, bez značajne interakcije navedenih poremećaja sa psihotičnim poremećajem. ZAKLJUČAK: Kod pacijenata sa ishemičnim moždanim udarom najveća je učestalost anksioznog poremećaja, zatim depresivnog poremećaja, a najređe se javlja psihotični poremećaj. Depresivni i anksiozni poremećaj značajno su če&scaron;ći kod žena, dok se psihotični poremećaji isključivo javljaju kod mu&scaron;karaca. Depresivni poremećaj značajno se če&scaron;će javlja u srednjem i starijem životnom dobu, anksiozni poremećaj se če&scaron;će javlja u mlađem i srednjem životnom dobu, dok se psihotične manifestacije javljaju najče&scaron;će u srednjem životom dobu. Depresivni i anksiozni poremećaj jednako se često javljaju kod pacijenata sa teritorijalnim i lakunarnim infarktom, dok se psihotične manifestacije isključivo javljaju kod pacijenata sa teritorijalnim infarktom. Ne postoji značajna korelacija između prisustva faktora rizika za moždani udar i pojave psihičkih poremećaja, iako je upadljivo odsustvo psihičkih poremećaja kod pacijenata bez faktora rizika za moždani udar. Nakon 3 meseca od moždanog udara nije primećena značajnija regresija simptoma psihičkih poremećaja. Anksiozni poremećaj i psihotične manifestacije se statistički značajno če&scaron;će javljaju kod infarkta u desnoj hemisferi, dok za depresivni poremećaj nije potvrđeno statistički značajno če&scaron;će pojavljivanje kod infarkta u levoj hemisferi. Psihički poremećaji kod pacijenata sa moždanim udarom če&scaron;će se javljaju kod pacijenata sa lezijama u karotidnom slivu, &scaron;to se povećava sa težinom lezije i veličinom stenoze. Ne postoji statistički značajna korelacija između lezija krvnih sudova u vertebrobazilarnom slivu i Willisovom poligonu sa pojavom psihičkih poremećaja. Nije dokazan značajan uticaj psihičkih poremećaja na oporavak bolesnika nakon moždanog udara. Dokazan je visok stepen udruženog javljanja depresivnog i anksioznog poremećaja.</p> / <p>INTRODUCTION: Stroke belongs to noninfectious diseases, which are considered the most common diseases of modern man. It is one of the most common causes of mortality and disability in the modern world. The many associated complications of stroke include mental disorders: depression, anxiety and psychotic disorders. Determining the relationship between stroke and mental disorders, as well as enlightening their underlying mechanism, represents a significant contribution to a better understanding of this very frequent disease, and an early treatment of these associated disorders should allow a faster and more complete recovery from stroke. OBJECTIVE: To determine characteristics of mental functioning after ischemic stroke, to determine the impact of lesion localization on development of certain mental disorders after stroke, to determine the impact of vascular status on development of mental disorders, and to determine the correlation between the associated mental disorders and the speed and degree of recovery of general life activities. MATERIALS AND METHODS: The research was conducted as a prospective study that included 101 ischemic stroke patients of both sexes, hospitalized at the Clinic of Neurology in Novi Sad. Data about the course of disease and stroke risk factors was collected and laboratory diagnostics was performed in all patients. All patients underwent brain computed tomography (CT) (or magnetic resonance imaging - MRI), and ultrasound examination of carotid and vertebrobasilar arteries and the circle of Willis. The degree of neurological deficit and functional recovery in the acute phase and at 3-month follow-up were assessed using the National Institute of Health Stroke Severity (NIHSS) scale, the Rankin scale, and the Barthel Index. All patients underwent psychological exploration of the mental status in the acute phase of stroke by using the Beck Depression Inventory 2 (BDI - 2), the State-Trait Anxiety Inventory (STAI), the Positive and Negative Syndrome Scale (PANSS), and the Cornell Services Index (CSI). Follow-up testing with the same tests was performed after 3 months. Statistical analysis included methods of descriptive statistics: tabular presentation of the frequency and percentages in case of nonparametric (nominal or ordinal) variables. Contingency tables were used to present relationships between two variables. In addition, measures of central tendency (arithmetic mean) and measures of dispersion (standard deviation) were used for parametric variables. The chisquared test was used to determine differences between groups for nominal measurement variables, Cramer&rsquo;s V was used to examine association between nominal levels of measurement. Association between interval measurement variables was measured by the Pearson correlation coefficient (r), and significance of differences between arithmetic means of more groups was determined by the analysis of variance (ANOVA). RESULTS: The study included 101 patients, 65.3% male and 34.7% female. The average age of patients was 60.69 years (median=62.00, standard deviation=10.828, statistical error=1.077). Stroke localizations were as follows: the right cerebral hemisphere in 38.6%, the left hemisphere in 34.7%, the cerebellum in 4%, the brainstem in 11.9%, and 10.9% of patients had multiple localizations. In 39.6% of patients, stroke was territorial, and in 59.4% lacunar. The distribution of risk factors for stroke was typical for the study area. Normal carotid arteries were found in 26.7%, 26.7% had diffuse atheromatosis, 27.7% had &lt;70% ACI stenosis, and 18.8% had &gt;70% ACI stenosis. As regards VB circulation, 52.5% had normal findings and 47.5% had pathological findings (stenosis and diffuse atheromatosis). As regards the circle of Willis, 54.5% had normal findings and 45.5% had pathological findings (stenosis and diffuse atheromatosis). Regarding mental functioning, 5.9% had depressive disorder, 29.7% had anxiety disorder, 9.9% had neurotic disorder, and 2% had psychotic disorder. In relation to sex, mental disorders were present as follows: depressive disorder in 3% of men and 11.4% of women, anxiety disorder in 25.8% of men and 37.1% of women, neurotic disorder in 7.6% of men and 14.3% of women, and psychotic disorder in 3% of men and none of women. With respect to age, among patients under 45 years of, age none had depressive disorder, 30% had anxiety disorder, 10% had psychotic disorder, and none had neurotic disorder. In the group of patients aged 46-65 years, 6.9% had depressive disorder, 22.4% had anxiety disorder, 12.1% had neurotic disorder, and 1.7% had neurotic disorder. In the group above 65 years of age, 6.1% had depressive disorder, 42.4% had anxiety disorder, 9.1% had neurotic disorder, and none had psychotic disorder. The distribution of responses obtained on the BDI-2 showed a higher prevalence of depressive disorder in patients with lesions in the left cerebral hemisphere. The distribution of responses obtained on the STAI showed a higher prevalence of anxiety disorder in patients who had lesion of the right hemisphere. The distribution of responses obtained on the CSI showed a higher prevalence of neurotic disorder in those who had multiple lesions. The distribution of responses obtained by the PANSS indicated a higher prevalence of psychotic disorder in those with lesion of the right hemisphere. Comparison of carotid artery lesions and mental disorders showed a progressive increase in the prevalence of mental disorders with increasing severity of the lesions, as well as a complete absence of mental disorders in people who had normal findings on carotids. The follow-up results showed that mental disorders (generally and individually) did not have a statistically significant effect on functional recovery of stroke patients. There were statistically significant comorbidities of depressive disorder and anxiety disorder, depressive disorder and neurotic disorder, and anxiety disorder and neurotic disorder, and no significant interactions of any of these disorders with psychotic disorder. CONCLUSION: In patients with ischemic stroke, anxiety disorder has the highest prevalence, followed by depressive disorder, whereas psychosis is the rarest. Depressive and anxiety disorders are significantly more common in women, while psychotic disorder occurs exclusively in men. Depressive disorder is significantly more common in the middle and old ages, anxiety disorder is more frequent in the younger and middle ages, while psychotic manifestations occur most often in the middle age of life. Depressive and anxiety disorders are similarly prevalent in patients with territorial and lacunar strokes, while psychotic manifestations occur exclusively in patients with territorial stroke. There is no significant correlation between the presence of stroke risk factors and mental disorders, although there is an evident absence of mental disorders in patients without stroke risk factors. Three months after stroke, no significant regression of the symptoms of mental disorders was observed. Anxiety disorder and psychotic manifestations are significantly more common in right hemispheric stroke, while as regards depressive disorder, there is no statistically significant association with left-hemispheric stroke. Mental disorders in stroke patients are more common in those with carotid lesions and increase in severity with increasing severity of lesion and degree of stenosis. There are no statistically significant correlations between lesions in the vertebrobasilar circulation or the circle of Willis and development of mental disorders. No significant impact of mental disorders on recovery from stroke was found. A high prevalence of comorbid depressive and anxiety disorders was proven/confirmed.</p>

Within this thesis the role of cognitive processes in irritable bowel syndrome (IBS) will be examined. A systematic review and meta-analysis of the rate of psychiatric comorbidity in IBS participants, relative to controls, was performed. Evidence supported heightened rates of psychiatric disorder. A novel hypothesis regarding overlapping cognitive vulnerability to IBS and psychiatric disorders was found to fit well with the pattern of comorbidity. Competing hypotheses and the potential moderators were examined. Overall, no single model of psychiatric morbidity in IBS could fully account for the results of the meta-analysis. The implications of this meta-analysis for a cognitive approach to IBS are discussed. Cognitive processes were directly investigated in two experiments. First, in a modified exogenous cueing task, which assessed attention to pain words, there was faster orienting towards, and engagement with pain words in IBS participants relative to controls. Next, participants completed a primed lexical decision task, which indexed interpretation biases by measuring response times to targets after ambiguous illness primes. Relative to controls, IBS participants’ responses were slower to target words presented after ambiguous illness primes, and demonstrated priming for targets related to the neutral meaning of the illness prime. In the second study, different IBS and healthy control participants completed an internet-based survey of autobiographical memory. Participants described and rated painful and emotional autobiographical events. IBS participants reported pain memories from a more observer perspective relative to controls, suggesting a possible coping strategy for pain content. Finally, three cognitive styles, alexithymia, rumination and self-blame, were evaluated using existing and novel self-report measures. Overall, when compared with healthy participants, IBS participants reported: less difficulty identifying feelings as indexed by the alexithymia measure; increased pain-focused rumination; and a general, negative self-blame. These results may imply a vigilance-avoidance model of cognitive processing in IBS.

Plusieurs études telles que le NESARC ont démontré la comorbidité chez les joueurs pathologiques dans la population générale et dans des échantillons cliniques. Le jeu pathologique se présente souvent avec des troubles comorbides tels que les toxicomanies, les troubles de l’humeur, les troubles anxieux et les troubles de la personnalité. Cette étude a été réalisée auprès de 40 joueurs pathologiques admis en traitement au Centre Dollard-Cormier, Institut universitaire sur les dépendances à Montréal. Les objectifs étaient d’évaluer : la consommation d’alcool et de drogues, la présence d’une détresse psychologique caractérisée par des symptômes et des syndromes cliniques ainsi que par des troubles de la personnalité et la prévalence du trouble de l’ÉSPT dans l’échantillon. L’ICJE a été utilisé pour évaluer la gravité du jeu. Les autres troubles ont été mesurés à travers l’IGT, l’AUDIT, le MCMI-III, le QÉT et l’ÉMST. Les résultats montrent que 65 % des participants présentent une consommation problématique d’alcool (25 % actuellement, 40 % dans le passé), 27,5 % une consommation problématique de drogues; 52,5 %, un diagnostic probable d’au moins un syndrome clinique (surtout anxiété et dépression), 55 %, un diagnostic probable d’au moins un trouble de la personnalité; 30 %, des symptômes du trouble d’ÉSPT et 17,5 %, un diagnostic probable du trouble. Alors, la comorbidité est présente chez les joueurs pathologiques de l’échantillon. Il est essentiel de l’identifier pour mieux répondre aux besoins particuliers de l’individu et l’aider avec les symptômes qui aggravent le problème de jeu et augmentent le risque de récidive. / Several studies such as the NESARC have demonstrated the comorbidity in pathological gamblers in the general population and in clinical samples. Pathological gambling often occurs with other comorbid disorders, such as addictions, mood disorders, anxiety disorders, and personality disorders. This study was conducted among 40 pathological gamblers admitted in treatment at Centre Dollard-Cormier, Institut universitaire sur les dépendances, in Montreal. The objectives were to assess the use of alcohol and drugs, the presence of psychological distress characterized by clinical symptoms and syndromes as well as by personality disorders, and the prevalence of PTSD in the gamblers of the sample. The CPGI was used to assess the severity of gambling. The other disorders were measured through the ASI, the AUDIT, the MCMI-III, the QÉT and the ÉMST. The results show that 65% of participants had a problem with alcohol (25% currently, 40% in the past), 27.5% presented a problematic drug use, 52.5% had a potential diagnosis of at least one clinical syndrome (mainly anxiety and depression), 55% had a potential diagnosis of at least one personality disorder, 30% presented symptoms of PTSD and 17.5% had a potential diagnosis of PTSD. In conclusion, comorbidity exists in the pathological gamblers of the sample. It is essential to identify it in order to better address the needs of the individual and to help him with the symptoms that worsen the gambling problem and increase the risk of recurrence.