Non-binary gender, vulnerable populations and mental health during the COVID-19 pandemic: Data from the COVID-19 MEntal health inTernational for the general population (COMET-G) study

BACKGROUND

The COVID-19 pandemic has brought significant mental health challenges, particularly for vulnerable populations, including non-binary gender individuals. The COMET international study aimed to investigate specific risk factors for clinical depression or distress during the pandemic, also in these special populations.

METHODS

Chi-square tests were used for initial screening to select only those variables which would show an initial significance. Risk Ratios (RR) were calculated, and a Multiple Backward Stepwise Linear Regression Analysis (MBSLRA) was followed with those variables given significant results at screening and with the presence of distress or depression or the lack of both of them.

RESULTS

The most important risk factors for depression were female (RR = 1.59-5.49) and non-binary gender (RR = 1.56-7.41), unemployment (RR = 1.41-6.57), not working during lockdowns (RR = 1.43-5.79), bad general health (RR = 2.74-9.98), chronic somatic disorder (RR = 1.22-5.57), history of mental disorders (depression RR = 2.31-9.47; suicide attempt RR = 2.33-9.75; psychosis RR = 2.14-10.08; Bipolar disorder RR = 2.75-12.86), smoking status (RR = 1.15-5.31) and substance use (RR = 1.77-8.01). The risk factors for distress or depression that survived MBSLRA were younger age, being widowed, living alone, bad general health, being a carer, chronic somatic disorder, not working during lockdowns, being single, self-reported history of depression, bipolar disorder, self-harm, suicide attempts and of other mental disorders, smoking, alcohol, and substance use.

CONCLUSIONS

Targeted preventive interventions are crucial to safeguard the mental health of vulnerable groups, emphasizing the importance of diverse samples in future research.

LIMITATIONS

Online data collection may have resulted in the underrepresentation of certain population groups.

Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study)

BACKGROUND

The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

METHODS

The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.

RESULTS

About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.

CONCLUSIONS

The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Students' mental health during the pandemic: results of the observational cross-sectional COVID-19 MEntal health inTernational for university Students (COMET-S) study

Introduction

The aim of the study was to search rates of depression and mental health in university students, during the COVID-19 pandemic.

Materials and methods

This is an observational cross-sectional study. A protocol gathering sociodemographic variables as well as depression, anxiety and suicidality and conspiracism was assembled, and data were collected anonymously and online from April 2020 through March 2021. The sample included 12,488 subjects from 11 countries, of whom 9,026 were females (72.2%; aged 21.11 ± 2.53), 3,329 males (26.65%; aged 21.61 ± 2.81) and 133 "non-binary gender" (1.06%; aged 21.02 ± 2.98). The analysis included chi-square tests, correlation analysis, ANCOVA, multiple forward stepwise linear regression analysis and Relative Risk ratios.

Results

Dysphoria was present in 15.66% and probable depression in 25.81% of the total study sample. More than half reported increase in anxiety and depression and 6.34% in suicidality, while lifestyle changes were significant. The model developed explained 18.4% of the development of depression. Believing in conspiracy theories manifested a complex effect. Close to 25% was believing that the vaccines include a chip and almost 40% suggested that facemask wearing could be a method of socio-political control. Conspiracism was related to current depression but not to history of mental disorders.

Discussion

The current study reports that students are at high risk for depression during the COVID-19 pandemic and identified specific risk factors. It also suggested a role of believing in conspiracy theories. Further research is important, as it is targeted intervention in students' groups that are vulnerable both concerning mental health and conspiracism.

The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic: Data from the international COMET-G study

INTRODUCTION

During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question.

MATERIAL AND METHODS

During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively.

STATISTICAL ANALYSIS

It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis RESULTS: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small.

CONCLUSIONS

The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health. Our findings, support previous suggestions concerning the need for a proactive targeted intervention to protect mental health more specifically in vulnerable groups.

Personality Organization and Depressive Symptoms Among Psychiatric Outpatients: The Mediating Role of Shame

ABSTRACT

Previous research has demonstrated relations between lower level of personality organization (PO) and multiple indices of mental health disturbances. The goal of this research was to examine whether experience of shame would mediate the relationship between PO and depressive symptoms in a sample of 321 Croatian psychiatric outpatients (64% female; mean age, 38.67 years). The total PO level exhibited positive associations with depressive symptoms and with all three subscales of shame ( p < 0.01). Characterological, behavioral, and bodily shame showed significant mediating effects in the PO-depression relationship, while controlling for the influence of age and sex. PO level seems to be strongly related to depressive disturbances, with the experience of shame representing one of the underlying mechanisms of this relationship. Given that patients with personality disorders ( i.e. , low PO level) suffer from poorer treatment outcomes for major mental disorders, more emphasis should be placed on psychotherapeutic management of shame-proneness.

“Flexible Assertive Community Mental Health Teams for the Treatment of Psychosis in Extraordinary Circumstances during Pandemics and Earthquakes 2020/2021: are we Flexible Enough?”

During the ongoing COVID-19 pandemic, two regions in Croatia, Zagreb and Petrinja in the Sisak-Moslavina County experienced strong earthquakes, on the March 22^nd 2020 and on the 29th of December 2020. Both earthquakes, but especially the later one resulted on severe damage of the regions and caused severe disruptions in (mental) health service delivery. In these circumstances, the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE), which was ongoing in Croatia from 2018-2022 aimed to implement flexible assertive community treatment as the new health care service for persons with severe mental illness (SMI). Since the pandemic and earthquakes have significantly influenced the life circumstances of all RECOVER-E project participants with SMI, we wanted further to examine the impact of health care delivery on mental health and the response to stress caused by a pandemic and earthquake in the patients with SMI involved in the project, in the first and second wave of the COVID-19 pandemics. Additionally, using case series, we will demonstrate the community mental health teams’ contributions in managing SMI after a double disaster in providing feasible, comprehensive, and accessible mental health services.1

Results of the COVID-19 mental health international for the general population (COMET-G) study

INTRODUCTION

There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study.

MATERIAL AND METHODS

During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively.

STATISTICAL ANALYSIS

Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables.

RESULTS

Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed.

CONCLUSIONS

The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

Experiences of healthcare staff providing community-based mental healthcare as a multidisciplinary community mental health team in Central and Eastern Europe findings from the RECOVER-E project: an observational intervention study

BACKGROUND

Community Mental Health Teams (CMHTs) deliver healthcare that supports the recovery of people with mental illness. The aim of this paper was to explore to what extent team members of five CMHTs newly implemented in five countries perceived that they had introduced aspects of the recovery-oriented, strength-based approach into care after a training week on recovery-oriented practice. In addition, it evaluated what the team members' perceptions on their care roles and their level of confidence with this role were.

METHOD

An observational intervention study using a quantitative survey that was administered among 52 health professionals (21 Nurses, 13 Psychiatrists, 9 Psychologists, 8 Social Workers) and 14 peer workers including the Recovery Self-Assessment Tool Provider Version (RSA-P), the Team Member Self-Assessment Tool (TMSA), and demographic questions was conducted. The measures were self-reported. Descriptive statistics were used to calculate the means and standard deviations for continuous variables and frequencies and percentages for categorical variables (TMSA tool and demographic data). The standard technique to calculate scale scores for each subscale of the RSA-P was used. Bivariate linear regression analyses were applied to explore the impact of predictors on the subscales of the RSA-P. Predictors with significant effects were included in multiple regression models.

RESULT

The RSA-P showed that all teams had the perception that they provide recovery-oriented practice to a moderately high degree after a training week on recovery-oriented care (mean scores between 3.85-4.46). Health professionals with fewer years of professional experience perceived more frequently that they operated in a recovery-oriented way (p = 0.036, B = - 0.268). Nurses and peer workers did not feel confident or responsible to fulfil specific roles.

CONCLUSION

The findings suggest that a one-week training session on community-based practices and collaborative teamwork may enhance recovery-oriented practice, but the role of nurses and peer workers needs further attention.

TRIAL REGISTRATION

Each trial was registered before participant enrolment in the clinicaltrials.gov database: Croatia, Zagreb (Trial Reg. No. NCT03862209 ); Montenegro, Kotor (Trial Reg. No. NCT03837340 ); Romania, Suceava (Trial Reg. No. NCT03884933 ); Macedonia, Skopje (Trial Reg. No. NCT03892473 ); Bulgaria, Sofia (Trial Reg. No. NCT03922425 ).

Psychodynamic phenomena in obese patients

Introduction

Obesity is one of the leading problems of today’s society. According to WHO, 650 million people worldwide are obese, which is 13% of total population (in Croatia 21.5%). There are various psychodynamic theories that interpret the psychological aspects of obesity.

Objectives

The aim of this paper is to present psychodynamic and contemporary psychiatric concepts that explain the interrelated phenomena presenting in obese patients.

Methods

The review of the literature included the investigation of the existing studies in the field of modern psychiatry, as well as previous knowledge in the field of psychodynamics.

Results

Obesity is associated with the emptiness of not recognizing one’s own emotions from hunger, and the need for constant replacement. The everyday life of the obese is filled with shame, an uncomfortable perception that is so intense that can be unbearable. The emptiness and shame which overwhelm and create discomfort cannot be fulfilled by constant food intake and are associated with pathological narcissism (grandiose or vulnerable), which in turn is associated with more regressive behaviour. Thus, obesity may sometimes be associated with addictive behaviours, and a cognition that a bad pattern of rewarding behaviour through food has been adopted in parallel with poor self-control.

Conclusions

Relationship between psychodynamic phenomena and obesity is complex and multidimensional. Further research is needed in order to ameliorate our understanding of these connections.

Disclosure

No significant relationships.

Pathological Narcissism, Negative Parenting Styles and Interpersonal Forgiveness among Psychiatric Outpatients

BACKGROUND

Pathological narcissism has previously been investigated with regard to negative parenting and interpersonal forgiveness, but inconsistent findings have been obtained in relation to its two phenotypic forms - grandiosity and vulnerability. Moreover, the role of negative parenting in the lack of forgiveness within narcissistic pathology has not been explored thus far. The aim of the current research was to investigate the complex relations among pathological narcissism, negative parenting, and interpersonal forgiveness in psychiatric outpatients.

SUBJECTS AND METHODS

A sample of 250 adult psychiatric outpatients (61% female; mean age 39.15 years) were enrolled in this study. The participants filled out the Pathological Narcissism Inventory (PNI), the Tendency to Forgive Scale (TTF), the Measure of Parental Styles (MOPS), and the Depression, Anxiety, Stress Scales (DASS21).

RESULTS

Narcissistic grandiosity and narcissistic vulnerability were positively correlated with mothers' and fathers' negative parenting, but this association was significantly stronger in the case of narcissistic vulnerability. Only narcissistic vulnerability was related to interpersonal forgiveness. In the mediation analysis, negative parenting was not directly related to interpersonal forgiveness, however, this association became significant after introducing narcissistic vulnerability. Narcissistic vulnerability served as a full mediator of the mothers' and fathers' negative parenting - interpersonal forgiveness relationships.

CONCLUSIONS

Narcissistic vulnerability seems to be more strongly related to negative parenting and interpersonal forgiveness than narcissistic grandiosity, while it also represents one of the underlying mechanisms of the negative parenting - interpersonal forgiveness relationship. The clinical implications of these findings are discussed in relation to pathological narcissism and lack of forgiveness.

Endometriosis, Pain and Mental Health

BACKGROUND

Endometriosis is a chronic and progressive disease which can significantly affect a woman's personal, as well as intimate and professional aspects of life. The aim of this study was to asses health-related quality of life and mental health status in patients with endometriosis, investigating also their relationship with endometriosis-related comorbid symptoms and conditions, such as pain and infertility.

SUBJECTS AND METHODS

An observational cross-sectional study involved 79 women with endometriosis. All patients filled the Endometriosis Health Profile (EHP-5), the Depression Anxiety Stress Scales (DASS-21) and the Visual Analogue Scale (VAS). Their medical data were retrieved from medical records. Data was analyzed using the SPSS 23.0 (IBM Corp., Armonk, NY).

RESULTS

Of all the patients evaluated in our study, 44.3% presented depressive symptoms and 25.3% presented anxiety, while 31.7% reported stress symptoms. Moderate correlations were found between results on EHP-5 and depression (r=0.515), stress (r=0.558) and VAS score (r=0.565). Furthermore, weak positive relationship was observed between EHP-5 and anxiety (r=0.295) and infertility (r=0.267). Additionally, moderate correlation was found between depression and infertility (r=0.519), while there was weak association between VAS score and stress (r=0.236).

CONCLUSIONS

This study showed complex relationships between symptoms and conditions manifesting in patients with endometriosis. Due to diversity of symptoms, potentially including mental health issues, it is important to emphasize the need for combined personalized treatment for these patients, taking into account both physical and psychological aspect of the disease.

Perceived Support for Recovery and Level of Functioning Among People With Severe Mental Illness in Central and Eastern Europe: An Observational Study

Background: Many people with severe mental illness experience limitations in personal and social functioning. Care delivered in a person's community that addresses needs and preferences and focuses on clinical and personal recovery can contribute to addressing the adverse impacts of severe mental illness. In Central and Eastern Europe, mental health care systems are transitioning from institutional-based care toward community-based care. The aim of this study is to document the level of functioning and perceived support for recovery in a large population of service users with severe mental illness in Central and Eastern Europe, and to explore associations between perceived support for recovery and the degree of functional limitations. Methods: The implementation of community mental health teams was conducted in five mental health centers in five countries in Central and Eastern Europe. The present study is based on trial data at baseline among service users across the five centers. Baseline data included sociodemographic, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for functional limitations, and the Recovery Support (INSPIRE) tool for perceived staff support toward recovery. We hypothesized that service users reporting higher levels of perceived support for their recovery would indicate lower levels of functional limitation. Results: Across all centers, the greatest functional limitations were related to participation in society (43.8%), followed by daily life activities (33.3%), and in education or work (35.6%). Service users (N = 931) indicated that they were satisfied overall with the support received from their mental health care provider for their social recovery (72.5%) and that they valued their relationship with their providers (80.3%). Service users who perceived the support they received from their provider as valuable (b = -0.10, p = 0.001) and who reported to have a meaningful relationship with them (b = -0.13, p = 0.003) had a lower degree of functional limitation. Conclusion: As hypothesized, the higher the degree of perceived mental health support from providers, the lower the score in functional limitations. The introduction of the community-based care services that increase contact with service users and consider needs and which incorporate recovery-oriented principles, may improve clinical recovery and functional outcomes of service users with severe mental illness.

COVID-19 Infodemic and Public Trust from the Perspective of Public and Global Mental Health

Crisis usually involves participants who trust and distrust each other, commonly in the same time. COVID-19 infodemic induced confidence crisis and distrust in authorities, science communities, governments and institutions can lead to harmful health behaviors and ill mental health and become a serious threat to public and global mental health as another kind of virus. Distrust mentality, conspiracy thinking and blame games may have detrimental effects not just on the individual level, but on the level of the whole groups, communities and global world. Public distrust and mistrust are related to the crisis in the domain of social and political relations, not only on the same country level, but also between different countries at regional or global level. Dynamics between public trust and mental health is a complex and bidirectional, ill mental health is causing and enhancing the inclination to confidence crisis, distrust, conspiracy theories and blame games and vice versa confidence crisis, distrust, conspiracy thinking and blame games are leading to ill mental health. It is important to have a holistic transdisciplinary integrative understanding of these dynamics and science-based treatment and prevention.

Psychiatry for Better World: COVID-19 and Blame Games People Play from Public and Global Metal Health Perspective

Blame games tend to follow crisis, be they at local, national or international level related to political, financial or health issues. COVID-19 crisis from the very beginning has been followed by divisive and disruptive psychosocial and political blame games. Active or passive blaming is an inherent feature of human beings in order to shift responsibilities onto others, single out a culprit, find a scapegoat and pinpoint a target. Finger pointing, blame games and scapegoating are associated with creation of binaries that identify agency as good or bad, right or wrong, moral or immoral. The scapegoat is expectedly always bad, wrong and immoral, commonly black evil. The detrimental effects of the COVID-19 blame games are seen in a lack of cohesion and coherence in the anti-COVID-19 solving strategies. Fighting the COVID-19 crisis all countries and nations need to join efforts on defeating it and to shift from a destructive blaming and zero-sum type of thinking to a much more creative, systemic and humanistic type. Effective response to COVID-19 is related to sowing the seeds for humanistic self and empathic civilization, rather than blaming, scapegoating and xenophobia.

COVID-19 Pandemia and Public and Global Mental Health from the Perspective of Global Health Securit

The Coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China and has spread all over the world and has caused huge threats to health and lives. It has affected different frontiers of lives and induced many psychiatric individual and collective problems such as panic, anxiety, depression, post-traumatic stress disorders, suspiciousness, infodemia, cacophony, xenophobia, racisms, etc. The COVID-19 outbreak has induced public and global mental health crisis as well as a huge psycho-social experiment. Psychiatry and other mental health sciences can play very useful role in supporting the well-being of COVID-19 patients and their families, healthcare personnel and the society. For successful fighting with present and future pandemics we have to learn more about psychiatric and psychological aspects of COVID-19 from the perspectives of public and global mental health.

The Importance of Psychodynamic Approach during COVID-19 Pandemic

The coronavirus (COVID-19) outbreak was labeled a global pandemic by the WHO in March of 2020. Understanding how crisis influence an individual's reactions to stressful events (and vice versa) is important in order to create meaningful and effective interventions. Our literature search have revealed lack of the papers related to psychodynamic approach to recent crisis. Psychodynamic places a large emphasis on defense mechanisms and unconscious mind, where upsetting feelings, urges, and thoughts that are too painful for us to directly look at are housed. Even though these painful feelings and thoughts are outside of our awareness, they still influence our behavior in many ways. Optimal application of psychodynamic approach offers the frame for acceptance of psychological stress in a more positive way and benefits psychological growth. We believe that including psychodynamic approach in the national public and mental health emergency system will empower Croatia and the world during (and after) COVID-19 pandemic crisis.

Reconstruction of a Thumb Defect Following Subungual Melanoma Resection Using Foucher's Flap

Dear Editor, The main challenge in the treatment of subungual melanoma in situ is obtaining adequate oncological resection while preserving the aesthetics and functionality of the affected digit (1). Traditionally, subungual melanoma in situ was treated with amputation of the distal phalanx of the digit, but management has recently become more conservative, attempting to preserve the full length of the digit (1). Although many recent studies support more conservative treatment by demonstrating successful results of the digit salvaging approach for both in situ and invasive subungual melanoma (1-3), there is still no agreed consensus in terms of the optimal surgical approach for this condition (1). It is the deep resection margin that is not uniformly accepted in the recent literature reports. Some authors recommend resection to the level of the periosteum (3,4), some include the periosteum (1), and some even perform a shave resection of the dorsal cortex of the distal phalanx (1). The reconstructive procedures also vary between authors, ranging from simple full thickness grafts (1,3,4) to toe free flaps (5). Reconstruction with a full thickness skin graft sometimes leads to complications, such as inclusion cysts and persistent hypersensitivity (1,3). These complications occur due to positioning the skin graft directly on the bone. A 31-year old women with a subungual melanoma in situ on her left thumb, diagnosed after several nail matrix biopsies, underwent a 5 mm margin resection of the entire nail complex with the distal part of the fingertip, including the distal phalanx periosteum. After intraoperatively confirming adequate tumor free margins, the residual defect measured 2×3 cm with exposed distal phalanx and without the distal fingertip (Figure 1). We reconstructed the defect using a pedicled innervated fasciocutaneous Foucher's flap (6) from the dorsum of the index proximal phalanx (Figure 2). Based on the first dorsal metacarpal artery and innervated by a branch of the superficial radial nerve, it provided stable soft tissue cover to the exposed bone, as well as fingertip sensation (Figure 3). The donor site was covered with a full-thickness skin graft taken from the volar side of the elbow. Postoperative course was uneventful with primary healing of all the wounds. Definite pathohistological analysis confirmed the diagnosis of in situ melanoma with adequate tumor resection margins. At three months follow-up, all the wounds were fully healed, there were no signs of local or regional recurrences, the hand was fully functional, and the patient was very satisfied with the appearance of the thumb (Figure 4, a and b). The patient achieved full sensory cortical reorientation. Although the finger sparing resection procedures for the treatment of subungual melanoma have not been clearly defined, we believe that the inclusion of the periosteum in the resection enhances the likelihood of obtaining tumor-free margins, especially the base, which is the most critical area due to the thinness of the nail matrix. Inclusion of the periosteum also ensures the complete removal of previous matrix biopsy scars. This extent of the resection necessitates reconstruction with an adipofascial or fasciocutaneous flap, preferably innervated if the fingertip is included in the resection. The defect in our patient was a full-thickness soft tissue defect extending to the level of the cortical bone, which included the distal fingertip due to the presence of pigmentation on the fingertip. Therefore, the ideal reconstructive option had to provide adequate soft tissue cover and be innervated to provide sensation to the fingertip. Foucher's flap is a reliable option for the cover of the thumb fingertip, and although traditionally used to resurface the thumb pulp, it provides excellent innervated cover for the thumb dorsum in cases like this, with minimal donor morbidity.

Many Faces of Déjà Vu: a Narrative Review

French expression standing for the phrase "already seen" is a déjà vu. It is thought that as much as 97% of the population have experienced déjà vu at least once in their lifetime and 67% experience it regularly. The explanations of this phenomenon in novels and poems include reincarnation, dreams, organic factors, and unconscious memories. In this narrative review connection between déjà vu and various other conditions has been mentioned: false memories, temporal lobe epilepsy and other neurological conditions. In psychiatric patients déjà vu phenomenon is more often seen in patients with anxiety and people with derealisation/ depersonalization. It seems that temporal region is the origin of déjà vu phenomena in both healthy individuals and in individuals with neurological and psychiatric conditions, but the exact mechanism of this phenomenon is however still unknown. More attention should also be given to déjà vu from philosophical and religious perspectives as well. Déjà vu is still an enigma which could only be revealed with multidisciplinary approach through cooperation between neurologists, brain scientists, psychiatrists and experimental psychologists.

Attitudes of Croatian patients with severe mental illness towards long-acting injectable antipsychotics

BACKGROUND

It has been shown that patients' attitudes towards long-acting injectable antipsychotics (LAIA) have the influence on the acceptance and use of this type of therapy. The aim of our study was to explore attitudes of patients because, according to our knowledge, there has been no similar research in Croatia thus far.

SUBJECTS AND METHODS

Two questionnaires were given to the total of 100 patients, the first one to patients treated with LAIA (group 1) and the second one to patients treated with oral antipsychotics (group 2).

RESULTS

Significantly more patients treated with LAIA find that good aspects of their medication outweigh the bad (p=0.014). Almost one third of patients treated with oral antipsychotics (n=16, 32%) quit taking medication when they feel better and 6 patients (12%) very often or often forget to take medication. Larger number of patients treated with LAIA feels much better since they have been taking their medication (group 1=82%, group 2=68%). Almost all patients treated with LAIA would recommend their therapy to other patients (92%), which is not the case with patients treated with oral antipsychotics (58%). 90% of patients decided to take LAIA because of suggestion given by their psychiatrists and 10% were persuaded by their psychiatrists. When given potential advantages of LAIA, 84% of patients said they found very positive the fact that they didn't have to think about taking their medication every day, 82% were fond of LAIA's simplicity, 68% considered positive that their psychiatrists had better control over their treatment and 66% were very content with their recovery.

CONCLUSION

The larger number of patients treated with LAIA is content with their therapy than patients treated with oral antipsychotics. Patients' attitudes have changed in a way that they don't find LAIA coercive anymore and most of them agreed to that type of therapy on a suggestion given by their psychiatrists.

Attitudes of Croatian psychiatrists towards long-acting injectable antipsychotics

BACKGROUND

Despite many advantages of long-acting injectable antipsychotics (LAIA), this type of therapy is still underused in routine practice. Since psychiatrists' attitudes play an important role in prescription rate of LAIA, we found it valuable to examine their attitudes because, according to our knowledge, there hasn't been similar research in Croatia so far.

SUBJECTS AND METHODS

In this research, we included the total of 48 psychiatrists. For research purposes, we created a questionnaire modeled on standardized questionnaire. Results are described with descriptive statistics and Likert scale was used to measure respondents' attitudes to statements.

RESULTS

The number of years of their experience in practice is expressed with median of 13.50 years with minimal value of 1.00 and maximum value of 36.00 years. Most of psychiatrists find that LAIA play an important role in treatment of schizophrenia (n=44, 93.62%) and that they tend to prescribe that type of therapy (n=39, 81.25%). Almost all of psychiatrists (n=45, 93.75%) agree or strongly agree that it is easier to control patients' disease if they are treated with LAIA rather than with oral therapy and 32 of them (68.08%) think that doctor-patient relationship is more successful when patients are treated with LAIA than with oral antipsychotics. According to their experience (n=32, 68.08%) patients prefer to be treated with oral antipsychotics instead of LAIA. We expressed approximate percentage of their patients treated with LAIA with median of 20%, with minimum value of 0.00% and maximum value of 70.00%.

CONCLUSION

According to the results of our research, attitudes of psychiatrists towards LAIA are mostly positive, but considering the fact that there is a small number of their patients who are treated with them, we emphasize that psychiatrists still prescribe oral antipsychotics much more often than LAIA. Despite positive attitudes of patients towards LAIA, majority of psychiatrists think that patients would rather choose oral therapy.

Effects of probiotic and phytogenic products on performance, gut morphology and cecal microflora of broiler chickens

Abstract. The trial involved 684 Cobb 500 broiler chicks in order to investigate the effects of probiotics and phytogenic additives on performance, gut morphology and cecal microbial concentrations. Birds were assigned to three treatments: control feed, treatment with addition of probiotics in feed and water and treatment with addition of phytogenic blend in feed. The results showed a significant improvement (P<0.01) in body weight gain and a numerical, but non significant (P>0.05) improvement in feed conversion ratio by adding both probiotics and phytogenics in feed. There were no statistically significant differences among treatments regarding total aerobes, anaerobes, lactic acid bacteria, bifidobacteria, enterococci, and Escherichia coli populations (P>0.05) in cecum of broilers. The gut morphology examination showed that probiotics had beneficial effect on jejunum morphology causing a significant (P<0.005) increase in villus height and villus surface area compared to other two groups. On the other hand, phytogenic additive had no effect (P>0.05) on villus height or villus surface area, but reduced the villus/crypt ratio (P<0.05), which may indicate that the improved production results in the group with added phytogenics are not directly connected with changes in gut integrity, but with other physiological mechanisms.