Hypochondriac fears and beliefs of medical students

Hypochondria is a mental disorder characterized by a preoccupation with fears that a person may be ill or suffering from a serious illness, based on a misinterpretation of problems that cannot be eliminated by appropriate medical reassurance. A special type of hypochondriasis known as Medical Student Syndrome (MSS) refers to student's fears and beliefs that they are ill or may become ill with the illnesses they are learning while studying in pre-clinical and clinical subjects. A cross-sectional study was conducted during the winter semester of the 2019/2020 school year, with a sample of 90 students of the first, third, and sixth year of the Faculty of Medicine, sampled on a random basis. Subjects completed the Illness Attitude Scale (IAS). The aim of study was to investigate whether there is a difference in the incidence of hypochondrial tendencies and beliefs in the students of the Faculty of Medicine in relation to the year of study. The mean values on certain subscales were statistically significantly higher in students of third compared to students of first and sixth year of medicine. Students who have not renewed a year were found to have significantly higher average scores on the Disease Concerns and Pain Concerns subscale, as well as Disease phobia compared to those who renewed the year, while Hypochondrial beliefs were statistically significantly higher in subjects who renewed the year compared to students who had not renewed the year. The presented results support the hypothesis that health anxiety and all its components among the medical students at the preclinical level is most pronounced in the third year of study, and that it shows declining trend in the later stages of study.

Obesity and schizophrenia: New drugs, new hopes

Obesity is one of the leading problems in our society. The spread of obesity in developed societies is reaching pandemic lengths. In schizophrenic patients obesity raises an important issue. Patients suffering from schizophrenia have a shorter life span compared to the general population. Prevalence of obesity in schizophrenic patients is high. Obesity is the key factor in developing a metabolic syndrome. Metabolic syndrome is a frequent somatic complication in schizophrenia. Nowadays, it is clear that metabolic syndrome shortens the lifespan of people who developed an illness. Because of this, the treatment of obesity represents a major problem. Review of currently approved medications for treatment of obesity is the goal of this paper.

Longitudinal monitoring of the course of depressive disorders: Careful monitoring of the course of depressive episode

No modern studies of the natural course of depression have been done since the nineteen fourties of the last century. A large number of depressive episodes spontaneously remit. Because of this, some psychiatrists call for more use of a therapeutic approach called watchful waiting, especially for milder forms of depression. At the Institute of mental health in Belgrade, from November 2019 until November 2021, a study in watchful waiting will be done. In this paper the methodology of the planned study is described.

Mechanisms of action of conspiracy theories

The paper discusses the reasons why conspiracy theories emerge (the desire to belong, survive, be close with the members of the group, and maintain a positive image of ourselves and the community). Theories and results of research about psychological factors that are believed to influence the emergence of conspiracy theories are presented. The authors conclude that belief in conspiracy theories is highly dependent on epistemological, existential, and social motives. Research has not yet shown that these theories serve to satisfy these motives, and it is even possible to the contrary, that these theories do not strengthen social cohesion at all, do not lead to improvement of self-esteem and a more positive image of ourselves or the group we belong to. Important questions remain open and more research needs to be done about the consequences of believing in conspiracy theories, especially in vulnerable populations, which have been found to have the highest motivation to accept these theories. The tendency to believe in conspiracy theories is a phenomenon influenced by many factors. Some of these factors are belonging to a lower socio-economic background, a lower educational level, a tendency to outsource one's own responsibility for life's failures, or to neglect the genetic and educational factors that led to it. However, many other factors, such as mental health status, also determine this phenomenon. Poorly integrated, deeply insecure personalities who have not overcome the schizoid-paranoid position of development, tend to perceive the environment as perceptual and threatening, with the aim to protect their own self from deeper disintegration.

A case report of the inaccuracy of the questionnaire as a meriod of the patient's condition

Scales for assessment of patients with depression are in use for several decades. Among the most used are Hamilton's depression scale and the younger Patient Health Questionnaire. Even though both are heavily used in research and clinical practice they are still controversial and with questionable usefulness. This case report shows that the question whether a patient is better or worse can be diametrically opposite depending on the scale used (using these two most influential ones as examples) and what are the reasons for this.

Congenital adrenal hyperplasia associated with mental disorders: A case report

Introduction: Congenital adrenal hyperplasia (CAH) is an inherited autosomal recessive disorder characterized by a defect in the synthesis of steroid hormones of the adrenal cortex. This defect results in elevated serum androgen levels. Androgens have been shown to have a significant effect on the developing brain during prenatal and postnatal period, which can lead to impaired neurocognitive functioning and contribute to the development of psychiatric disorders. The aim: In this paper, we will present a patient with CAH who developed serious psychiatric problems during adolescence. The aim of this case report is to discuss a possible connection between these two conditions and to consider possible diagnostic and therapeutic interventions. Case report: The patient was diagnosed with the classic form of CAH at birth. After months of corticosteroid substitution therapy, the patient was surgically treated at 7 months of age with vaginoplasty and clitoroplasty. The patient developed serious psychiatric problems from the depressive-anxiety spectrum in the early adolescent period, followed by impaired impulse control and aggression. This report illustrates the diagnostic and therapeutic interventions conducted at the Clinical Department for Children and Adolescents of the Institute of Mental Health. Conclusion: Given the abundant evidence on the impact of CAH on cognitive ability and psychosocial functioning, it is necessary to develop and implement complementary multidisciplinary diagnostic and therapeutic interventions in these patients. Such interventions would aim to prevent the onset of psychiatric comorbidities and consequently improve the quality of life and functionality of these patients.

COVID-19 pandemic: Impact on children and adolecents

The global pandemic caused by Corona Virus Disease 2019 (COVID-19) has led to major lifestyle changes in people living in the affected countries. Namely, most countries declared the state of emergency which included the implementation of different precautionary measures, such as restriction of movement, travel ban, isolation, social distancing and wearing protective equipment. The global fight with the unknown virus generated an abundance of different, often contradictory and inconsistent information. These new changes can have a potentially major impact on the physical and mental health of both children and adults. Children are a particularly vulnerable population in crisis situations. Although research shows that children and young people exhibit clinically significantly milder forms of COVID-19 compared to adults, their vulnerability is reflected in a greater susceptibility to develop serious psychological consequences. Mental problems of children most often develop due to the inability to adequately understand the new situation, fear, separation from peers, changes in the mental state of parents and greater susceptibility to abuse and neglect. Also, systematic changes in the country (closure of educational institutions, reduced workload or closure of health institutions or institutions of support and assistance to children and vulnerable individuals) contribute to the difficulty of overcoming the pandemic. These changes especially affect children with pre-existing mental disorders, neurodevelopmental difficulties, and children from vulnerable and minority groups who require more care and services from different support systems. In order to avoid harmful consequences for the health of children, we will present recommendations focused on children and parents, which are intended for the easier overcoming of crisis situations such as the current pandemic.

Use of psychopharmaceuticals during COVID-19 treatment

No specific cure has been found since the beginning of the COVID-19 pandemic. In the treatment of infection caused by SARS-CoV-2 virus, therapeutic protocols include drugs of different groups: antiviral drugs, antibodies, antibiotics, anti-inflammatory drugs, etc. It can be expected that a certain number of patients who are receiving therapy with psychopharmacotherapy will get sick from COVID-19, but we also know that the infection itself has certain psychological manifestations. Due to the above, the use of psychopharmacotherapy together with other drugs in the therapy of COVID-19 is sometimes unavoidable. Co-administering these drugs has to be with caution due to the potential prolongation of the QTc interval, drug interactions at the CYP enzyme level, and the associated potential for agranulocytosis.

Duration of psychiatric appointments for patients with Psychosis spectrum disorders in Serbia: Is it significantly prolonged by DIALOG+ psychosocial intervention?

Despite national and international guidelines recommending inclusion of psychotherapy and psychosocial interventions as regular part of treatment for patients with psychosis spectrum disorders (PSD), outpatient psychiatric care in Southeastern Europe (SEE) is mostly limited to medication prescription. DIALOG+ is a recently developed technology-based, patient centered psychosocial intervention that provides an economically viable intervention for treatment and comprehensive evaluation of multiple life domains. Its effectiveness in a range of psychiatric disorders has been shown in several studies conducted in high-income countries. Before an ongoing study evaluating DIALOG+ implementation and effectiveness in developing SEE countries is completed, we aimed to explore general impressions of mental health clinicians towards such an intervention and to compare the duration of treatment as usual (TAU) with DIALOG+ enriched appointments of PSD outpatients. The attendees of the national professional educational symposium were presented with DIALOG+, after which they completed a short survey on their general impressions towards the intervention. To obtain the information regarding duration of psychiatric appointments for patients with PSD in Serbia, we used data from a currently ongoing randomized clinical trial where DIALOG+ is being tested for effectiveness. The impressions of the survey (n=110) from mostly psychiatrists and psychiatry residents towards the concept of this intervention were overwhelmingly positive. However, the question arose if TAU is being prolonged by DIALOG+ to the extent that might limit its implementation. Although significant difference in average session duration was observed between DIALOG+ and TAU (31.96±16.47 vs. 19.75±6.11 minutes, p<0.01), providing structured interventions and patient evaluation might be of additional benefit for long term care and quality of life of PSD patients. To the best of our knowledge, this was the first evaluation of the duration of psychiatric appointments for outpatients with PSD in Serbia. Present information could be useful for different stakeholders in education of MH workers and implementation of DIALOG+ in the local settings.

Treatment of mentally disturbed persons in medieval Serbia

The treatment of mental health patients in Serbia in the Middle ages was the same as in other European countries. Medicine of that time was based on science, the use of magic rituals and witchcraft was banned. Doctors from Serbia, Byzantium and the national doctors had been educated in Salerno and Montpellier, the most developed centers of medicine. They took the exam in front of the government Medical testimony. The development of medicine was followed in the Hodoloski code which was considered the oldest record of folk medicine and the Hilandar medical code which represented a collection of medieval scientific European medicine and Serbian medicine culture (XII-XV). The first Serbian hospital was established in Hilandar in 1199. The founder was Saint Sava who wrote the rules about the work of the hospital. Actually, it was the practice for all medical facilities that were opened later. We know about mental diseases and healing in Serbia from Lives of Saints in monasteries Zica (from 1207) and Decani (1327) and from the biography of Medieval ruler (king) Stephen of Decani. The illustrations of healing some patients with mental diseases were shown on frescoes and in the lives of saints. In Medieval Serbia, there were 49 foreign doctors working (15 in XIV, 30 in XV and 4 in XVI century) and until Turkish conquest Serbia took a very important place in Medieval Europe. Objective of this paper is to show where psychiatric patients were treated in Medieval Serbia, the way they were treated, who treated them, where the hospitals were and what kind of treatment wereapplied.