Psychiat Danub
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Neuro-protection in this context is an important concept in the treatment of patients in the early, prodromal phase of psychosis, otherwise known as the 'At Ultra High Risk Mental State'. Neuro-protection as described here refers to the use of agents to control the process of apoptosis, which occurs more rapidly in the earliest phases of schizophrenia. There is a need to identify medications with fewer side effects than anti-psychotics in order to treat at risk mental states, or prodromal psychosis. ⋯ Hence it has been suggested that Oestrogen may be neuroprotective. Studies have shown that the addition of oestradiol to anti-psychotics in the treatment of schizophrenia in females increased the efficacy of the treatment, which suggests that oestrogen does indeed have a neuroprotective action. However oestrogen has never been used in 'at ultra high risk mental states', perhaps because of concern regarding side effects.
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Suicidality is one of the great challenges in contemporary psychiatry. Suicidal patients are often misdiagnosed in clinical practice. It is very important to evaluate possible comorbidity in diagnostic assessment of suicidal patients. ⋯ Because of heterogeneity of the BPD, pharmacologic treatment has evolved to some particular dimensions of BPD rather than the disorder in its entirety. The dimensions include affective instability, impulsive aggression and identity disturbance. Effective medication management reduces the overall suffering of the patient and enables to make greater use of psychotherapeutic interventions which is very important for BPD patients with BD comorbidity.
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When looking back in the history of psychiatry, the concept of reactivity had very variable impact on ethiological considerations. If classification of mental disorders is taken as a proxy, it seems that this impact is presently at the lowest that it has been in the last hundred years. ⋯ He pleads for a rethinking of the current position as stated in ICD-10. Reintroduction of a certain degree of the reactivity concept into the classification seems to be required.
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Comparative Study
Post traumatic stress disorder, depression and anxiety among family medicine residents after 1992-95 war in Bosnia and Herzegovina.
The traumatic events experienced in Bosnia and Herzegovina during the 1992-1995 conflict may have a lasting effect on the mental health of the citizens, characterized by high rates of post-traumatic stress disorder (PTSD), depression, and anxiety. A diagnosis of PTSD, depression, and anxiety among family physician residents could affect their ability to diagnose and treat patients for depression, anxiety and PTSD. ⋯ PTSD prevalence of 10.3% and depression and anxiety prevalence of 21.8%, was found. The anxiety symptoms score was significantly higher amongst FMR who were GPs (1.69+/-0.66) than medical students (1.40+/-0.41, t-test=2.219, P=0.029) during the war.
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In this editorial we will first use the findings of epidemiological research to show that the closer we get to brain dysfunction, the higher is the suicide risk (Where?). Secondly, a distinction will be made between the proximate and ultimate causation of suicide behaviour as a biological phenomenon (Why?). Using the evolutionary psychiatry approach, the ultimate causation of suicide could answer the question why does suicidal behaviour exist at all? Third, we will review the most attractive recent molecular genetic findings in the field of suicidology genetics (How?). These three perspectives will in turn lead us to summarise where, why and how suicide risk is generated?