Publications by authors named "Milan Latas"

26 Publications

  • Page 1 of 1

The Role of Psychotherapy in the Treatment of Patients with Non- alcoholic Fatty Liver Disease and Obstructive Sleep Apnea.

J Gastrointestin Liver Dis 2021 12 21;30(4):477-484. Epub 2021 Dec 21.

University of Belgrade, Faculty of Medicine, Belgrade; Niko Miljanić Institute of Anatomy, Belgrade, Serbia.

Background And Aims: Non-alcoholic fatty liver disease (NAFLD) is a metabolic disease with extensive multi- organ involvement, whose extra-hepatic manifestations include diabetes mellitus type 2, cardiovascular disease, obstructive sleep apnea (OSA), chronic kidney disease, and polycystic ovary syndrome. Our hypothesis was that there was a strong psychological component in NAFLD and OSA suffering patients and that psychotherapy would be helpful in the treatment of the mentioned diseases.

Methods: Of 144 initially selected patients (with NAFLD, obesity and OSA), 32 patients agreed to undergo psychotherapy, and 31 therapy-naive NAFLD and OSA patients agreed to participate as controls.

Results: Psychological evaluation revealed that self-esteem rose significantly after one-year psychotherapy (p=0.005). Body mass index (BMI) was significantly lower after psychotherapy, followed by the changes in laboratory results. Binomial logistic regression revealed that the reduction of BMI in high probability led to self-esteem improvement (p=0.03).

Conclusions: Psychotherapy was an efficient supporting method in the treatment of patients with NAFLD, obesity and OSA. It raised self-esteem and stimulated the motivation for further treatment of obesity, as one of the important factors for NAFLD and OSA. Still, it is advisable to use psychotherapy in combination with other clinical methods of treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15403/jgld-3758DOI Listing
December 2021

Internet use during coronavirus disease of 2019 pandemic: Psychiatric history and sociodemographics as predictors.

Indian J Psychiatry 2020 Sep 28;62(Suppl 3):S383-S390. Epub 2020 Sep 28.

Department for Affective Disorders, Clinic of Psychiatry, Clinical Center of Serbia, Belgrade, Serbia.

Coronavirus disease of 2019 (COVID-19) pandemic and related containment measures have grossly affected the daily living and created a need for alternative ways of social communication and entertainment. The aim of this study was to explore the use of various Internet contents depending on sociodemographics and on psychiatric history of participants. This cross-sectional, population-based study is a part of a wider international multicenter study. A total of 1275 participants across Serbia (71.1% of females; average age = 41.81 ± 12.52 years) were recruited using two-level chain-referral sampling method. The participants filled in an anonymous online questionnaire that included questions on sociodemographic data, psychiatric history, and various aspects of increased Internet use since the pandemic. The data were analyzed using a series of multiple logistic regressions. About two-thirds of the sample reported using Internet more during the pandemic. All of the tested regression models, apart from models predicting browsing religion and travel/tourism, were significant, explaining from about 2% (for the contents specific for COVID-19) up to 34.4% (for the sexual content) of variance of use. Reporting a previously diagnosed psychiatric disorder was a significant predictor of greater Instagram use and browsing sexual and sport-related content since the pandemic. To the best of our knowledge, the study is the first to report on the relationship between Internet using and mental health, during COVID-19 pandemic, in the Balkan region. The findings showed various patterns of the increased use of Internet contents since the pandemic referring to both potentially positive and negative Internet influences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/psychiatry.IndianJPsychiatry_1036_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659784PMC
September 2020

The Sexuality of Sex Workers: Sexual Arousability and the Sexual Profile of Women Engaged in Prostitution in Serbia.

Psychiatr Danub 2020 Nov;32(Suppl 4):583-592

Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Background: In a view of sex work being a sexual behavioural activity, the main objective of our research was to explore the sexuality of sex workers in Serbia regarding to intensity of their sexual arousability.

Subjects And Methods: The research was conducted on 30 sex workers and 30 controls of randomly selected social and demographic characteristics, without any signs of psychiatric morbidity. For the evaluation of the intensity of sexual arousability, SAI (Sexual Arousability Index) questionnaire was used.

Results: The analysis of the main total scores of the SAI for the sex workers and control participants showed no statistically significant difference in the overall intensity of arousability (p>0.05). However, item by item analysis of the questionnaire showed qualitative difference in sexuality between sex workers and controls, related to certain aspects of sexuality.

Conclusions: These findings allow the space for further research in the way of identifying origins of qualitative issues in the sexual profile of sex workers, in correlation to women who are not sex workers, i.e. whether they had been result of potential biological, specific psychodynamic factors, or have been formed as a result of the direct influence of the sex work.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2020

Anxiety disorders and medical illness comorbidity and treatment implications.

Curr Opin Psychiatry 2019 09;32(5):429-434

Belgrade University School of Medicine and Institute of Mental Health, Belgrade, Serbia.

Purpose Of Review: To review recent studies which assess comorbidity, that is, prevalence of co-occurrence, relationships and treatment implications between anxiety disorders and various medical illnesses.

Recent Findings: The prevalence rates of anxiety disorders in patients with medical illnesses are high, with percentage up to 29% in patients with epilepsy, 48.9% in patients with multiple sclerosis, 30.1% in patients with Parkinson's disease, 30% in patients with cardiovascular disease, 47.0% in patients with diabetes mellitus, and so on. The most prevalent anxiety disorders among individuals with somatic illnesses are generalized anxiety disorder and panic disorder. In addition, various medical illnesses are highly prevalent in samples of patients with anxiety disorders. Anxiety disorders co-occurring with medical illnesses have a number of clinical implications, including a greater severity and negative impact on treatment outcome of both medical illnesses and anxiety disorders.

Summary: It is important for clinicians to look for possible anxiety disorders among patients with medical illnesses. Further studies need to ascertain how to best treat individuals suffering from both anxiety disorders and medical illnesses, and focus on the issue of causality when these conditions co-occur.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/YCO.0000000000000527DOI Listing
September 2019

Reliability of the bicaudate parameter in the revealing of the enlarged lateral Ventricles in schizophrenia patients.

Psychiatr Danub 2018 Jun;30(2):150-156

Clinics for Psychiatry "Laza Lazarević", Belgrade, Serbia.

Introduction: In schizophrenia patients the lateral ventricle enlargement has mostly been reported in relationship with smaller cortical and/or subcortical brain volumes; and it has been observed that ventricular system growth may be a consequence of the smaller caudate nucleus volume. Bicaudate parameters have been used in the Alzheimer dementia and Huntington's chorea diagnosing in order to evaluate brain changes and the enlargement of the lateral ventricles.

Subjects And Methods: This study has been carried out on 140 patients out of which 70 patients (30 men and 40 women) who met the ICD 10 criteria for schizophrenia and 70 healthy controls (30 men and 40 women) matched on sex and age with the studied group. All of them underwent direct caudatometry and volume computation based on MRI scans.

Results: Except for the bicorporal line, for all the parameters were obtained the statistically highly significant differences between the examined and control groups. Significant correlation was established for the majority of bicaudate parameters and volumes of the caudate nuclei and lateral ventricles.

Discussion: Enlargement of the lateral ventricles is one of the most frequent MRI finding in schizophrenia patients. Ventricles are enlarging gradually and frontal horns are more affected than other parts. The increased volumes of the caudate nuclei signalized that ventricular enlargement is not the consequence of the caudate atrophy.

Conclusion: Bicaudate parameters are reliable parameters for the quick orientation in order to assess the enlarged ventricles in schizophrenia patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.24869/psyd.2018.150DOI Listing
June 2018

Preoperative anxiety and implications on postoperative recovery: what can we do to change our history.

Minerva Anestesiol 2018 11 5;84(11):1307-1317. Epub 2018 Apr 5.

Department of Anesthesiology, McGovern Medical School, UTHealth Houston, TX, USA -

Preoperative anxiety can influence the intensity of postoperative pain and anesthesia and analgesia requirement. In certain types of surgery, anxiety may even increase postoperative morbidity and mortality. The goal of this narrative review is to remind anesthesiologists that anxiety measurement using specific tools can be done in clinical practice, to present the implications of preoperative anxiety on postoperative patient recovery, and to acknowledge the importance of a dedicated anesthesia plan in the management of anxious adult patients. Preoperative assessment performed several weeks before surgery in an outpatient clinic is a reasonable option to give information about surgery, anesthesia and postoperative pain. This is the time to assess patient preoperative anxiety by using VAS-A. If high anxiety level is detected early, the patient can be referred to a psychologist for preoperative preparation. This is consistent with the guidelines for enhanced recovery after surgeries, which underline the importance of patient-doctor discussion about hospitalization and perioperative care. Patients with preoperative anxiety could benefit from multimodal analgesia, including non-pharmacological methods, such as cognitive therapy and music therapy and relaxation. The authors' opinion is that greater education about preoperative anxiety consequences in the surgical community is needed. A systemized approach and guidelines about the management of preoperative anxiety should be followed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S0375-9393.18.12520-XDOI Listing
November 2018

Is Balint training associated with the reduced burnout among primary health care doctors?

Libyan J Med 2018 Dec;13(1):1440123

g Institute of Epidemiology, Faculty of Medicine , University of Belgrade , Belgrade , Serbia.

The aim of our study was to examine whether the participation in Balint group is associated with the reducing burnout syndrome among primary health care doctors. This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Out of 210 doctors, 70 have completed Balint training for a period of at least 1 year, whereas 140 doctors have never attended this training (the Non-Balint group). The level of burnout among physicians was assessed with the Serbian translation of the original 22-item version of the Maslach Burnout Inventory - Human Services Survey which defines burnout in relation to emotional exhaustion, depersonalization and personal accomplishment. We found that 45.0% of the Non-Balint participants and 7.1% of the Balint-trained participants responded with symptoms of high level of emotional exhaustion, with a statistically significant difference (p < 0.001). In relation to depersonalization, 20% of the Non-Balint subjects were highly depersonalized compared to 4.4% of the Balint-trained subjects, with a statistically significant difference (p < 0.001). Regarding the personal accomplishment, 21.4% of the Non-Balint subjects and 7.1% of the Balint-trained subjects had a perception of low personal accomplishment, with a statistical significance (p < 0.001). In the multiple ordinal logistic model, with emotional exhaustion as a dependent variable, statistically significant predictor was female gender (OR = 2.51; p = 0.021), while Balint training was obtained as a protective factor (OR = 0.12; p < 0.001). Non-specialists were detected as a risk factor for depersonalization (OR = 2.14; p = 0.026) while Balint group was found as a protective factor (OR = 0.10; p < 0.001), according to the multiple ordinal logistic regression analysis. Regarding the reduced personal accomplishment, our results indicated that nonspecialists were at risk for this subdimension (OR = 2.09; p = 0.025), whereas Balint participants were protected (OR = 0.18; p < 0.001). Participation in Balint groups is associated with the reduced burnout syndrome among primary health care doctors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/19932820.2018.1440123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844034PMC
December 2018

Psychiatrists' treatment preferences for generalized anxiety disorder.

Hum Psychopharmacol 2018 01 20;33(1). Epub 2017 Dec 20.

Sydney Medical School - Nepean, Discipline of Psychiatry, University of Sydney, Sydney, Australia.

Objective: The objective of this study is to ascertain psychiatrists' treatment preferences for generalized anxiety disorder (GAD) and compare them to the same psychiatrists' treatment preferences in the hypothetical scenario that treatment is to be administered to themselves as patients.

Methods: A questionnaire was completed by 221 psychiatrists from 3 Balkan countries. They were asked to indicate their treatment preferences for patients with GAD and for themselves as patients.

Results: A large majority of psychiatrists chose selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors as preferred treatment option for GAD patients. Fewer psychiatrists selected benzodiazepines and pregabalin and about one third chose psychotherapy. The majority of psychiatrists chose the same treatments for their patients and for themselves, with main differences being in terms of pharmacotherapy (especially benzodiazepines) being less frequently recommended and psychotherapy being more frequently recommended as preferred treatment option for psychiatrists as patients.

Conclusions: Treatment preferences for GAD by psychiatrists in the 3 West Balkan countries were mostly in accordance with treatment guidelines and treatment preferences for patients and for psychiatrists as patients were mostly concordant. However, some psychiatrists were more likely to choose pharmacotherapy for patients and psychotherapy for themselves as patients. These findings have implications for education of psychiatrists and for efforts to improve treatment guidelines and mental health services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hup.2643DOI Listing
January 2018

Prescribing practices in Southeastern Europe - focus on benzodiazepine prescription at discharge from nine university psychiatric hospitals.

Psychiatry Res 2017 12 25;258:59-65. Epub 2017 Sep 25.

Mental Health Protection Clinic, Clinical Center of Nis & Faculty of Medicine, University of Nis, Nis, Serbia.

There is much concern about the widespread long-term use of benzodiazepines. Our manuscript addressed its use in the region of Southeastern Europe, which seems extensive, but insufficiently explored. At nine university psychiatric hospitals (Croatia, Macedonia and Serbia), we retrospectively analyzed discharge summary documents to find the prevalence of discharge benzodiazepine prescriptions and the prescribed benzodiazepine doses. This study included 1047 adult subjects and showed that 81.9% of them had benzodiazepines prescribed in the discharge summary document, with high mean daily dose of around 5mg lorazepam equivalents. Factors associated with the prescriptions were exclusively clinical factors (diagnosis of schizophrenia spectrum disorders, more lifetime hospitalizations, psychiatric comorbidity, co-prescription of antidepressant or mood stabilizer, shorter duration of the hospitalization), while socio-demographic factors were not found to influence benzodiazepine discharge prescriptions. Similarly, factors which influenced the prescription of higher daily benzodiazepine dose were more lifetime psychiatric hospitalizations and co-prescription of antidepressant or mood stabilizer, as well as the diagnosis of mental/behavioral disorders due to substance use and co-prescribed antipsychotic. Our data are emphasizing an urgent need for guidelines and improved education of both health care professionals and patients, in order to prevent long term benzodiazepine (mis)use and related side-effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2017.09.059DOI Listing
December 2017

Medical students' health-related quality of life--a comparative study.

Vojnosanit Pregl 2014 Aug;71(8):751-6

Background/aim: Previous studies on medical students' subjective perception of health and health-related quality of life (HRQoL) showed inconclusive results. Moreover, there are no published studies to compare HRQoL of medical students to non-medical university students. The aim of the study was to assess subjective perception of health-related quality of life (HRQoL) in medical students' sample, to compare it with non-medical university students and to ascertain predictors of better perception of HRQoL in medical students.

Methods: Scores of all domains on the Mental and Physical Component Summary subscales and total score of the Short Form Health Survey (SF-36), used for assessment of HRQoL in samples of 561 medical and 332 non-medical university students were assessed and compared. In addition, linear regression to identify predictors of better perception of mental and physical components of HRQoL and overall HRQoL in the sample of medical students was used. The dependant variables were subscores and total score with the SF-36, and independent variables were certain sociodemographic and academic characteristics of the students.

Results: Medical students had statistically significantly higher scores on the Mental Component Summary and total SF-36 score compared to non-medical students. Linear regression analysis demonstrated that higher scores of Physical Component Summary were associated with age, male sex and the year of studies. The Mental Component Summary were associated with age, male sex, the year of studies and marital status. The total SF-36 score was associated with age, male sex and the year of studies.

Conclusion: Medical students perceive their health much better than other university students do, but female, older and second grade medical students have worse perception of their HRQoL. Those points should be potential target areas for specific prevention and treatment in order to achieve better HRQoL.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/vsp1408751lDOI Listing
August 2014

[How do we treat generalized anxiety disorder?].

Srp Arh Celok Lek 2014 Mar-Apr;142(3-4):204-12

Introduction: In addition to significant prevalence of generalized anxiety disorder (GAD) and related consequences, it seems that this disorder has not been studied sufficiently in Serbia.

Objective: The aim of this study was to investigate the understanding of psychopathology and the adequate treatment of patients with GAD by psychiatrists in Serbia.

Methods: The study comprised 84 doctors - psychiatrists and neuropsychiatrists who were engaged in treatment of patients with GAD. Anonymous survey was used as the basic instrument, which collected information about the socio-demographic and professional data, experience in treating GAD and understanding psychopathology of GAD, as well as the first and the second choice therapy for patients with GAD.

Results: The majority of psychiatrists (62.2%) indicated the symptoms of distress/tension and slightly lower percent (36.6%) designated the symptoms of worry/anxiety as the key symptoms of GAD when it was diagnosed.The results showed that almost all patients (96.5%) had been treated with benzodiazepines before coming to psychiatrists. Most psychiatrists preferred the use of SSRI/SNRI antidepressants (76.2%), usually in combination with benzodiazepines (71.4%) for the treatment of patients with GAD; however, if these doctors got GAD, the preference of benzodiazepine use would be significantly lesser (45.2%) than for the treatment of their patients. Preference for the use of SSRI/SNRI antidepressants was significantly more frequent in physicians with completed residency.

Conclusion: The understanding of psychopathology and treatment practice for patients with GAD in this sample of psychiatrists in Serbia is mostly consistent with the current trends for GAD treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/sarh1404204lDOI Listing
October 2015

Personality disorders and anxiety disorders: what is the relationship?

Curr Opin Psychiatry 2014 Jan;27(1):57-61

Clinic for Psychiatry, Clinical Center of Serbia and Belgrade University School of Medicine, Belgrade, Serbia.

Purpose Of Review: To systematically review the recent studies which examined the co-occurrence and relationships between anxiety disorders and personality disorders.

Recent Findings: The prevalence rates of personality disorders in patients with anxiety disorders are high, with 35% in posttraumatic stress disorder, 47% in panic disorder with agoraphobia and generalized anxiety disorder, 48% in social phobia, and 52% in obsessive-compulsive disorder. There is a high rate (39%) of the DSM cluster C personality disorders among individuals with anxiety disorders. Moreover, anxiety disorders are highly prevalent in samples of people with personality disorders, especially borderline personality disorder (80-84.8%). Personality disorders co-occurring with anxiety disorders have a number of clinical implications, including an increased risk of suicide, greater severity of anxiety disorders, and negative impact on the treatment outcome of anxiety disorders.

Summary: It is important for the clinicians to look for possible personality disorders among patients with anxiety disorders. Further studies need to ascertain how best to treat individuals suffering from both anxiety disorders and personality disorders and focus on the issue of causality when these conditions co-occur.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/YCO.0000000000000025DOI Listing
January 2014

Serbian translation of the 20-item Toronto Alexithymia Scale: psychometric properties and the new methodological approach in translating scales.

Srp Arh Celok Lek 2013 May-Jun;141(5-6):366-70

Sleep Research Unit, Toronto Western Hospital, University Health Network, Toronto, Canada.

Introduction: Since inception of the alexithymia construct in 1970's, there has been a continuous effort to improve both its theoretical postulates and the clinical utility through development, standardization and validation of assessment scales.

Objective: The aim of this study was to validate the Serbian translation of the 20-item Toronto Alexithymia Scale (TAS-20) and to propose a new method of translation of scales with a property of temporal stability.

Methods: The scale was expertly translated by bilingual medical professionals and a linguist, and given to a sample of bilingual participants from the general population who completed both the English and the Serbian version of the scale one week apart.

Results: The findings showed that the Serbian version of the TAS-20 had a good internal consistency reliability regarding total scale (alpha=0.86), and acceptable reliability of the three factors (alpha=0.71-0.79).

Conclusion: The analysis confirmed the validity and consistency of the Serbian translation of the scale, with observed weakness of the factorial structure consistent with studies in other languages. The results also showed that the method of utilizing a self-control bilingual subject is a useful alternative to the back-translation method, particularly in cases of linguistically and structurally sensitive scales, or in cases where a larger sample is not available. This method, dubbed as 'forth-translation' could be used to translate psychometric scales measuring properties which have temporal stability over the period of at least several weeks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/sarh1306366tDOI Listing
December 2015

Psychiatrists' psychotropic drug prescription preferences for themselves or their family members.

Psychiatr Danub 2012 Jun;24(2):182-7

Clinic for Psychiatry, Clinical Center of Serbia, Pasterova 2, 11 000 Belgrade, Serbia.

Background: Psychiatrists' preference for certain medications is not only determined by their efficacy and side effect profile but may also depend on the psychiatrists' beliefs about specific therapeutic effects based on their own observation and experience. We aimed to evaluate which antipsychotic or antidepressant drugs psychiatrists would prefer for themselves, their partners and children in case of a mental illness.

Subjects And Methods: The study was conducted among psychiatrists in Serbia. The sample consisted of 90 psychiatrists who were asked to complete the questionnaire about their drug selection in hypothetical situations of becoming ill with schizophrenia or depression or these conditions occurring in their partners and children.

Results: In case of schizophrenia, risperidone was the first choice made by most psychiatrists for themselves, their partners or children, followed by clozapine, haloperidol and olanzapine. In case of depression, SSRIs and SNRIs were generally favored, with sertraline and escitalopram being the preferred medications for psychiatrists, partners and their children. With regards to depression, 82.3% of participants would opt for an antidepressant as monotherapy or in combination, but 13.3% would opt for anxiolytic monotherapy. The preferred doses were slightly lower than the recommended ones, especially for antipsychotic agents.

Conclusions: Most psychiatrists would take or administer atypical antipsychotics or SSRIs as the first choice for themselves, their partners or children. These preferences are mostly in accordance with current treatment guidelines, but there is still room to narrow the gap between guideline recommendations and psychiatrists' medication choices in personally meaningful situations.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2012

[Analysis of test anxiety in medical students].

Med Pregl 2010 Nov-Dec;63(11-12):863-6

Medicinski fakultet, Beograd.

Introduction: Most students experience some level of anxiety during the exam. However, when anxiety affects the exam performance, it represents a problem. Test anxiety is a special form of anxiety, which is characterised with somatic, cognitive and behavioural symptoms of anxiety in situations of preparing and performing tests and exams. Test anxiety turns into a problem when it becomes so high that it interferes with test preparation and performance. The objective of this study was to ascertain the presence of test anxiety in medical students and to analyze some aspects of test anxiety in medical students of different gender, at different years of studying and possibility of failing a year.

Material And Methods: The study sample consisted of 198 students of Belgrade University School of Medicine of all years. Test anxiety was assessed by the Test Anxiety Inventory.

Results: The following results have been obtained in the study: 1. Medical students generally present moderate level of test anxiety; 2. female students have statistically significant more intense symptoms of test anxiety than male students. 3. the most intense symptoms are in the 3rd year and the least are in the 4th year of studies; 4. there is no statistically significant difference in the presence of symptoms of test anxiety among the students who have repeated one of the years of studies and regular students.

Conclusion: There is a considerable number of medical students who have intense symptoms of test anxiety and these students require help and support.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/mpns1012863lDOI Listing
June 2011

Reliability of the Hamilton Rating Scale for Depression: a meta-analysis over a period of 49 years.

Psychiatry Res 2011 Aug 26;189(1):1-9. Epub 2011 Jan 26.

Institute of Medical Statistics and Informatics, University of Belgrade, School of Medicine, Dr Subotica 15, Belgrade, Serbia.

The aim of this study was to provide a comprehensive meta-analytic review of the reliability of the Hamilton Rating Scale for Depression (HRSD) for the period 1960-2008, taking into consideration all three types of reliability: internal consistency, inter-rater, and test-retest reliability. This is the first such meta-analytic study of a clinician-administered psychiatric scale. A thorough literature search was conducted using MEDLINE and PsycINFO. The total number of collected articles was 5548, of which 409 reported one or more reliability coefficients. The effect size was obtained by the z-transformation of reliability coefficients. The meta-analysis was performed separately for internal consistency, inter-rater and test-retest reliability. A pooled mean for alpha coefficient in random effects model was 0.789 (95%CI 0.766-0.810). The meta-regression analysis revealed that higher alpha coefficients were associated with higher variability of the HRSD total scores. With regard to inter-rater reliability, pooled means in random effects model were 0.937 (95%CI 0.914-0.954) for the intraclass correlation coefficient, 0.81 (95%CI 0.72-0.88) for the kappa coefficient, 0.94 (95%CI 0.90-0.97) for the Pearson correlation coefficient, and 0.91 (95%CI 0.78-0.96) for the Spearman rank correlation coefficient. A meta-regression analysis showed positive association between inter-rater reliability and publication year. Test-retest reliability of HRSD ranged between 0.65 and 0.98 and generally decreased with extending the interval between two measurements (Spearman r between the duration of interval and test-retest reliability figures=-0.74). Results suggest that HRSD provides a reliable assessment of depression. Figures indicate good overall levels of internal consistency, inter-rater and test-retest reliability, but some HRSD items (e.g., "loss of insight") do not appear to possess a satisfactory reliability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2010.12.007DOI Listing
August 2011

Oral health status of psychiatric in-patients in Serbia and implications for their dental care.

Croat Med J 2010 Oct;51(5):443-50

Department of Public Health, School of Dentistry, University of Belgrade, Dr Subotica 1, 11 000 Belgrade, Serbia.

Aim: To determine oral health status and identify predictors of oral health in a representative sample of psychiatric in-patients in Serbia.

Methods: The study included 186 psychiatric in-patients and 186 control participants without psychiatric illness matched to the study group by age, sex, marital status, education level, employment, and monthly income. Dental examinations were done in both groups to measure the following indices of oral health: decayed, missing, and filled teeth (DMFT) index; community periodontal index; and plaque index. Participants were also interviewed about their dental health behavior and their medical records were examined.

Results: Psychiatric in-patients had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than controls. The average DMFT score in the patient group was 24.4 and 16.1 in the control group (P<0.001). Periodontal diseases were significantly more prevalent among psychiatric in-patients than among controls (P<0.001). The average plaque index for patients was 2.78 and 1.40 for controls (P<0.001). Multiple regression analysis demonstrated that 1) DMFT index was associated with age, male sex, duration of mental illness, use of antidepressants, time since the last visit to the dentist, and snacking frequency; 2) community periodontal index was associated with male sex; and 3) plaque index was associated with age, male sex, education level, employment, monthly income, tooth brushing technique, and snacking frequency.

Conclusion: Psychiatric in-patients in Serbia have poorer oral health than healthy controls. It is necessary to intensify preventive dental care in this vulnerable population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3325/cmj.2010.51.443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2969139PMC
October 2010

[Fear of body symptoms and sensations in patients with panic disorders and patients with somatic diseases].

Srp Arh Celok Lek 2009 Nov-Dec;137(11-12):659-63

Introduction: A cognitive model of aetiology of panic disorder assumes that people who experience frequent panic attacks have tendencies to catastrophically interpret normal and benign somatic sensations--as signs of serious illness. This arise the question: is this cognition specific for patients with panic disorder and in what intensity it is present in patients with serious somatic illness and in healthy subjects.

Objective: The aim of the study was to ascertain the differences in the frequency and intensity of "catastrophic" cognitions related to body sensations, and to ascertain the differences in the frequency and intensity of anxiety caused by different body sensations all related to three groups of subjects: a sample of patients with panic disorder, a sample of patients with history of myocardial infarction and a sample of healthy control subjects from general population.

Methods: Three samples are observed in the study: A) 53 patients with the diagnosis of panic disorder; B) 25 patients with history of myocardial infarction; and C) 47 healthy controls from general population. The catastrophic cognitions were assessed by the Agoraphobic Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ). These questionnaires assess the catastrophic thoughts associated with panic and agoraphobia (ACQ) and the fear of body sensations (BSQ). All study subjects answered questionnaires items, and the scores of the answers were compared among the groups.

Results: The results of the study suggest that: 1) There is no statistical difference in the tendency to catastrophically interpret body sensations and therefore to induce anxiety in the samples of healthy general population and patients with history of myocardial infarction; 2) The patients with panic disorder have a statistically significantly more intensive tendency to catastrophically interpret benign somatic symptoms and therefore to induce a high level of anxiety in comparison to the sample of patients with the history of serious somatic illness (myocardial infarction) and the sample of healthy general population.

Conclusion: The tendency to catastrophically interpret benign somatic symptoms and therefore to inducea high level of anxiety in patients with panic disorder, confirms the cognitive aetiology model of panic disorder and suggests that it should be the focus of prophylactic and therapeutic management of patients with panic disorder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/sarh0912659lDOI Listing
March 2010

[Panic attacks simulate presence of somatic illnesses].

Med Pregl 2009 Mar-Apr;62(3-4):165-70

Institut za psihijatriju, Klinicki centar Srbije, Beograd.

Introduction: Panic attacks are characterized with sudden attacks of anxiety with numerous somatic symptoms, such as palpitations, tachycardia, tachypnea, nausea, vertigo. The objective of this study was to analyze symptoms of panic attacks in patients with panic disorder, especially, to determine the specific relationship of somatic and neurological symptoms of panic attacks in boundaries of somatic systems.

Material And Methods: The study sample consisted of 97 patients with primary diagnosis of panic disorder, without any acute, severe and unstable somatic illness. The presence and frequency of symptoms of panic attacks were estimated by the Panic Disorder Questionnaire.

Results: The study results indicate that the most frequent symptoms of panic attacks were cardiological signs (heart pounding or racing) and trembling, followed by unsteady and fainting feeling symptoms, sweating, respiratory symptoms and gastroenterological symptoms. The results of correlation analyses indicate that symptoms of panic attacks classified into cardiovascular, gastro-enterological, respiratory and neurootological systems show statistically significant correlations.

Conclusion: The results of analyses of symptoms of panic attacks point to their intercorrelation. This specific association of the symptoms, if they are examined on their own in the patients, could lead to false clinical manifestation of some somatic illness. Therefore, it is necessary to analyze adequately and make the proper differential diagnosis of patients with panic disorder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/mpns0904165lDOI Listing
August 2009

Co-occurrence of Axis I and Axis II disorders in female and male patients with panic disorder with agoraphobia.

Compr Psychiatry 2008 Nov-Dec;49(6):537-43. Epub 2008 Mar 28.

Discipline of Psychological Medicine, University of Sydney, Sydney/Penrith, NSW 2751, Australia; Department of Psychological Medicine, Nepean Hospital, Sydney/Penrith, NSW 2751, Australia.

Objective: The aim of this study is to compare female and male patients with panic disorder with agoraphobia (PDA) for the co-occurring Axis I and Axis II (personality) disorders, to better understand sex differences in PDA.

Methods: The Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders, Clinician Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders were administered to 157 consecutive outpatients (112 females and 45 males) with principal diagnosis of PDA, who sought treatment at the 2 anxiety disorders clinics. Women and men with PDA were then compared with regard to the type and frequency of the co-occurring Axis I and Axis II disorders.

Results: Women with PDA had a statistically greater tendency to receive co-occurring Axis I diagnoses and a greater number of Axis I diagnoses than men. Such a difference was not found for personality disorders. However, no sex difference was found for the mean number of co-occurring Axis I and Axis II diagnoses per patient. There were significantly more women with at least one co-occurring anxiety disorder. Women had a significantly higher frequency of specific phobia, whereas men were diagnosed with hypochondriasis and past alcohol abuse or dependence significantly more often. With regard to Axis II disorders, the only significant sex difference pertained to the higher frequency of dependent personality disorder among women.

Conclusions: The results of this study suggest that there are more similarities than differences between sexes in the co-occurring Axis I and Axis II disorders. Still, the relatively specific relationships between PDA and excessive alcohol use in men and between PDA and dependent personality traits and personality disorder in women seem important and have implications for clinical practice and treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.comppsych.2008.02.009DOI Listing
February 2009

Are there gender differences in catastrophic appraisals in panic disorder with agoraphobia?

Depress Anxiety 2007 ;24(8):545-52

University of Sydney, Discipline of Psychological Medicine, and Nepean Hospital, Penrith, New South Wales, Australia.

Our aim in this study was to compare panic-related catastrophic appraisals between women and men with panic disorder with agoraphobia (PDA). One hundred two outpatients with PDA (75 women and 27 men) participated. Two instruments for the assessment of catastrophic appraisals, Agoraphobic Cognitions Questionnaire and Panic Appraisal Inventory, were administered before and after cognitive-behavioral therapy (CBT) that also included pharmacotherapy in three-fourths of the patients. Female and male patients did not differ significantly in terms of their tendency to anticipate catastrophic consequences of panic, before or after CBT-based treatment. For both females and males, the tendency to make catastrophic appraisals decreased significantly with treatment. We conclude that among patients with PDA there are no gender differences in catastrophic appraisals of panic sensations and symptoms. The apparently higher risk of panic recurrence in women does not seem to be related to their panic-related catastrophic appraisals. These findings also support a notion that there is no gender difference in response to CBT-based treatment of PDA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/da.20245DOI Listing
March 2008

[Relationship of psychiatric comorbidity and treatment of panic disorder and agoraphobia].

Srp Arh Celok Lek 2006 Jul-Aug;134(7-8):267-72

Introduction: Besides numerous studies that examined various aspects of comorbidity in patients with panic disorder and agoraphobia and numerous studies that examined efficacy of different treatment modalities in these patients, there was no study that examined relationship of overall psychiatric comorbidity and treatment of patients with panic disorder and agoraphobia.

Objective: The objective of the study was to establish the effect of psychiatric comorbidity on treatment efficiency of patients with panic disorder and agoraphobia.

Method: The sample of the study consisted of 119 patients with primary diagnosis of panic disorder and agoraphobia. The therapy of patients was based on the use of individual integrative model of treatment, which incorporated psycho-pharmaceuticals (benzodiazepines and antidepressants) and cognitive-behavior therapy. Symptom severity was estimated by Panic and Agoraphobia Scale before and after the completion of treatment. Patients with comorbidity and patients without any comorbidity were compared by MANOVA and ANOVA with repeated measures.

Results: The results of the study showed that 91% of patients met diagnostic criteria of comorbid psychiatric disorder and these patients had more severe clinical picture than patients without any comorbid disorder before the treatment. The results also showed that, after the completion of treatment, there was a significant reduction of all analyzed symptoms, that the effects of treatment were significantly better in patients with psychiatric comorbidity and that comorbid psychiatric disorders had no negative effect on the main goals of the treatment.

Conclusion: Based on these results, it may be concluded that: in patients with panic disorder and agoraphobia and comorbid psychiatric disorders, the pharmacotherapy must be based on simultaneous use of antidepressants and benzodiazepines, while standard cognitive-behavior therapy of patients with panic disorder and agoraphobia must be modified in case of the existing comorbid psychiatric disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/sarh0608267lDOI Listing
November 2006

[Gender differences in psychopathologic features of agoraphobia with panic disorder].

Vojnosanit Pregl 2006 Jun;63(6):569-74

Klinicki centar Srbije, Institut za psihijatriju, Beograd, Srbija i Crna Gora.

Background/aim: To examine gender differences in the major psychopathologic features in agoraphobia with panic disorder.

Method: The study was conducted as a clinical study. The sample consisted of 119 patients, 32 men (26.9%) and 87 women (73.1%) with the basic diagnosis of agoraphobia with panic disorder. All the patients were evaluated with the clinical instruments suitable for the assessment of various clinical features associated with agoraphobia with panic disorder--questionnaires (the Hopkins Symptom Checklist 90, the Panic Appraisal Inventory, the Fear Questionnaire, the Beck Anxiety Inventory, and the Beck Depression Inventory), and the clinical rating scale (the Panic and Agoraphobia Scale). After the data collection, the sample was divided into two groups by the gender. Then the groups were compared.

Results: There were no differences between the genders in the global psychopathologic features (the age at the onset of a disorder, duration of a disorder, severity and frequency of panic attacks, intensity of general psychiatric symptoms, intensity of general anxiety and depression). The women, howerer, reported a subjective perception of a more severe agoraphobic avoidance and males were significantly more likely than the females to anticipate the serious somatic consequences of panic attacks and worry about somatic health.

Conclusion: There were a few gender specific psychopathologic features in patients with agoraphobia with panic disorder, so further studies would be necessary to come to a more precise conclusion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/vsp0606569lDOI Listing
June 2006

Predictors of work disabilities in patients with panic disorder with agoraphobia.

Eur Psychiatry 2004 Aug;19(5):280-4

Institute of Psychiatry, Clinical Center of Serbia, Pasterova 2, Belgrade 11000, Serbia and Montenegro.

Objective: The aim of this study was to ascertain predictors of work insufficiency in patients with panic disorder (PD) with agoraphobia (AG).

Method: Linear regression was used to identify predictors of work insufficiency in a sample of 72 consecutive outpatients with PD with AG. Intensity of work insufficiency was ascertained from modified National Institute of Mental Health Panic Questionnaire (NIMH PQ). That represented dependent variable. Independent variables were demographic data, duration of illness, presence of comorbid current major depression episode, presence of any personality disorder and scores on the Panic and Agoraphobia Scale (PAS) subscales: panic attacks, AG (avoidance behavior), anticipatory anxiety and worries about health.

Results: Patients reported severe work insufficiency. The best predict variable for the work insufficiency in patients with PD with AG was high score on the PAS dimension of AG.

Conclusion: Patients generally reported severe effects of PD with AG on work efficacy and the results suggested that the impaired work efficacy was the most associated with avoidance behavior. These results recommend that the treatment of PD with AG patients should be related to decreasing avoidance behavior in order to establish adequate work performance in patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eurpsy.2004.05.008DOI Listing
August 2004

Treatment of panic disorder with agoraphobia in an anxiety disorders clinic: factors influencing psychiatrists' treatment choices.

Psychiatry Res 2004 Jan;125(1):41-52

Department of Psychological Medicine, Nepean Hospital and University of Sydney, P.O. Box 63, Penrith, NSW 2751, Australia.

The main objective of this report was to identify patient characteristics that led psychiatrists in an academic anxiety disorders clinic to make a decision about intensive treatment of patients with panic disorder with agoraphobia (PDA) with cognitive-behavioral therapy (CBT) alone, CBT plus a high-potency benzodiazepine (CBT+BZ) or CBT combined with BZ and an antidepressant, fluoxetine (CBT+BZ+AD). On the basis of their clinical judgment and collaborative negotiation with the patient, psychiatrists chose one of the three treatment modalities for 102 PDA outpatients. Two stepwise logistic regressions were performed to explore pre-treatment patient characteristics the psychiatrists may have considered in choosing among these treatments. One regression examined the decision to add BZ to CBT, while the other examined the decision to add AD to CBT+BZ. Psychiatrists generally used combination treatments in patients with more severe PDA. CBT alone was a more likely choice for dominant anxiety-related cognitive phenomena. Patients with prominent panic attacks and somatic symptoms were more likely to be treated with CBT+BZ, while those who also had significant depressive symptoms and higher disability levels were more likely to receive CBT+BZ+AD. Patients in all three treatment groups showed significant reduction in symptoms during intensive treatment and reached similar end states. In a clinic setting where CBT is accepted as the basic treatment for PDA, psychiatrists added BZ to control prominent panic symptoms and added AD to elevate depressed mood and help cope with marked disability. These choices appear rational and resulted in substantial clinical improvement at the end of intensive treatment in the clinic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2003.11.001DOI Listing
January 2004

Panic disorder patients at the time of air strikes.

Depress Anxiety 2002 ;16(4):152-6

Hunter Mental Health Service and University of Newcastle Faculty of Medicine and Health Sciences, Newcastle, NSW, Australia.

We assessed the impact of real danger on several aspects of the panic disorder (PD) patients' psychopathology and level of disability. At the time of the NATO air strikes on Belgrade, 84 PD patients who were in partial or complete remission were administered the Panic and Agoraphobia Scale (PAS). All had been treated previously, and the majority (58.3%) were taking antipanic medications. The PAS, which was used as part of the regular follow-up assessment battery for PD patients, measures the overall severity of PD and the severity of key aspects and components of PD. Compared to the PAS assessments made before the onset of air strikes, the PAS assessments made at the time of air strikes showed significant differences in terms of decreased overall severity of PD, fewer health concerns, decrease in the level of disability, and greater intensity and frequency of anticipatory anxiety. Differences on the measures of panic attacks and agoraphobic avoidance were negligible. These results suggest that there is no relationship between panic attacks and real danger and lend support to the notion that panic attacks and fear induced by real danger are different phenomena. Contrary to the expectations of many PD patients, the presence of real danger does not seem to be associated with deterioration in their functioning, and PD patients can be reassured that they are not likely to cope worse under conditions of danger.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/da.10067DOI Listing
April 2003
-->