Klinika za Psihijatriju

Zagreb - Centar, Croatia

Klinika za Psihijatriju

Zagreb - Centar, Croatia

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Stalekar V.,Klinika Za Psihijatriju
Medicina Fluminensis | Year: 2010

In the article a brief survey of the history of family therapy is given on the basis of which the development of new concepts and therapy models is reviewed. The division of family and marital therapies into a number of models is primarily of a didactic nature, since in practice these models overlap and are to a considerable degree complementary. In this article a systemic, dynamic, structural, strategic, transgenerational, experiential therapy is mentioned. Each therapy model interprets family system dysfunctions in a unique manner. Each of the therapy models interpret dysfunctions of a family system, however, the appropriateness of different therapies in the context of acute and chronification of family problems is discussed. Also, the paper emphasizes the importance of creating goals in family and marital therapy (placing the symptoms in the context of family dynamics, homeostasis and reflection of former to new relations, motivation to change the relations and not only to deal with the symptom) regardless of the therapy model used. We explain0 the importance of having the family create the goals and give the possible solutions in the therapy as well as the importance of strengthening marital subsystem and natural allies, encouragement of a more natural functioning of family subsystems (married couple, parents, children subsystems), diminishing pathological forms of communication, supporting "I" expressions, developing capacities of empathy, understanding, acknowledgment and tolerance of differences, defining the roles and rules, encouragement of the consistency, work on personal boundaries, individuation and autonomy without a fear of family breaking apart as well as keeping the consciousness of family togetherness. Also indications and genogram use are shown.


Grkovic J.,Klinika Za Psihijatriju
Medicina Fluminensis | Year: 2010

Acute illness of a family member represents an important stressful event for the whole family. Usually, the family confronted with a sudden illness, cannot adequatly cope with new demands for change in functioning. No matter which acute illness or injuries are involved - heart attack, stroke or traffic accident, sudden illness is an acute life event associated with the termination of the usual course of everyday life within the family (Holmes - Rahe Scale of stressfull events puts the injury or disease to sixth place scoring stressfulness). Stress due to illness of a family member always is the succesor of the previous family life experiences and its history of driving changes, as well as the meaning of illness which family adds to new stressors. The fact that one family member became ill, changes the whole current family situation. Serious physical illness is often complicated by unpleasent emotion of all family members - anxiety, depression, adaptive difficulties and disorientation, as well as with a change in redistribution of roles that occurs within the family. It is actually a series of stresses that can cause psychological and physiological responses in most family members. Each family will react according to their specific resources. Coping mechanisms are various - from active coping, distancing, getting social support and taking responsability to avoidance or denial of the problem. Doctors who treat patients directly, are the most important in providing information to family members, reducing their anxieties and in such way helping them to overcome the unsafe and shaken family situation.


Graovac M.,Klinika Za Psihijatriju
Medicina Fluminensis | Year: 2010

Adolescence ia a developmental phase after which we enter the adulthood. Family phase where offprings reach adolescence is a specific phase in the life of a family and places new tasks and goals not only infront of adolescent but also infront of the family as a whole. Having an adolescent in the family certainly, for every member of that family, includes being in a physiologically critical, demanding period of developmental processes. To be a parent to an adolescent is a different position in the parenthood than being a parent in the earlier phases. There are many things that happend to the child and to the parents for the first time in their lives. During the process of growing up and separation from parents new significant others begin to appear. These new object relations and new connections create a very slippery field between the adolescent and his or her parents. The generational gap among parents and adolescent is inevitable. However, adolescence does not happen only to adolescents, it also affects parents in a different, specific way. Developmental tasks and developmental processes in adolescence require, both from adolescents and their parents, high capacities for adjustment and maturation of their relationship. Along with the adolescent growing up, his or her family also experiences changes. Parents of the adolescent, just like a mother for a little baby, have to be present so that their adolescent could separate from them and develop, grow up. Emotional climate in which a child or a adolscent enters adulthood is one of the most important factor of mental health.


Britvic D.,Klinika Za Psihijatriju
Medicina Fluminensis | Year: 2010

Family represents biopsychosocial system, consisting divided roles, hierarchy, boundaries and relations, using regulatory mechanisms aims to homeostasis. Family system is social micro system, deeply plunged in society and under influence of stress, crises and psychotraumatic events. According to the intensity of events, there are differences between stress and crisis, stress is used for less serious, daily events while distress or crisis is used for more serious events, with more complex adaptation. Between family and stress events there are two-way connections. Family could be helpful in struggling with stressful events but it itself could be source of stressful events. Family help and support depends on duration and nature of events as well as how much itdisturbs family homeostasis. Exceptionally unpleasant, sudden events that cause family structure misbalance, result in disturbance of regulation mechanisms into family and demand huge effort of all family members to control stressful events. In some cases, when family misses to overcome development phase's demands, it itself might become source of stress. Recoveries of stress usually appear spontaneously, due to personal potential as well as family healing potentials. Physician, who knows well family members, their inner potentials, relationships, sometimes secrets, could initiate crisis solution. Members of extended family as well as others closely related to family might have important role in dealing with crisis.


Stalekar V.,Klinika Za Psihijatriju
Medicina Fluminensis | Year: 2010

In the last decades some major changes in the life of the families as a social construct have been occurring. Those changes include a growing number of working and economicalyindependent women, postponed age of marrying, increased number of families without offspring, greater number of two-generation families, higher rates of divorce and single parent families, as well as growing number of extramarital couples, single households, alternative family communities, etc. However, family as a basic social unit in the traditional and in the modern societies has an equally important role. This paper argues about the consequences of the above mentioned changes on the family of today that has lost its firm points in the changing times. Family definitions, dynamics of family functioning through life cycles, and dynamics of functional and dysfunctional families in the face of social changes are discussed. Also, this paper focuses on the marital and family relations which despite the numerous social and structural changes withhold their basic purpose of mutual satisfaction of emotional and physical needs and the socio economic security. The level of family functioning is discussed through the quality of marital relation which is product of continues creation between partners and is originated in the relation to oneself and influenced by the early emotional relations. The first concepts of family development theory are presented in the comparison with contemporary view of the family dysfunctionality and its consequences on the psychological life of family members.


Begovac B.,Klinika za Psihijatriju | Begovac I.,Klinika za Psiholosku Medicinu
Socijalna Psihijatrija | Year: 2011

Group cohesion is an important therapeutic factor in the group psychotherapeutic work and one of the eleven primary therapeutic factors in the work with a group according to Yalom. The aim of this work is to define the term of group cohesion in the light of Yalom's concept. It is proposed to separate this term from the term of group coherence and dynamic matrix. This article is trying to show the importance of group cohesion in daily work with groups in different therapeutic settings. Short clinical vignettes are presented to illustrate group cohesion.


Ivanusic J.,Klinika za psihijatriju | Harangozo A.,Klinika za psihijatriju
Medicus | Year: 2014

Pain is a significant healthcare problem. A great number of people around the world suffer from chronic pain. A painful condition may be a result of somatic and sometimes even incurable diseases, but it may be also associated with injury, inflammation or other tissue damages that are more intense than expected. In a certain number of pain patients, healthcare professionals cannot identify its cause. In these cases, where constant pain cannot be medically explained, it may be a clinical presentation of a psychiatric disorder. Whatever its origin, pain affects activity levels, e.g. work and social activities, and it can represent both a personal and societal burden. Pain is influenced by personal, social and environmental characteristics, including personality, gender, race, socioeconomic status and physical environment (e.g. weather and climate). Chronic pain patients remain a difficult diagnostic and management challenge. Chronic pain requires a multidisciplinary treatment. Besides the pharmacological treatment that can include antidepressants, anticonvulsant drugs and atypical antipsychotics to alleviate both anxiety and depression and the pain itself, psychological and psychosocial interventions can be practiced in order to relieve pain and emotional suffering. Cognitive-behavioural therapy could be a part of a holistic approach to treating chronic pain patients. It has additive effects to medical therapies. Psychological approach can reduce stress, tension, anger, hopelessness and negative consequences on daily activities, and improve the quality of life.


Jaksic N.,Klinika za Psihijatriju | Curzik D.,Klinika za Psihijatriju | Jakovljevic M.,Klinika za Psihijatriju
Socijalna Psihijatrija | Year: 2012

Antisocial personality disorder and psychopathy are often considered synonyms, but it is a case of two related yet unidentical clinical entities. While antisocial disorder is a formal diagnosis in the DSM-IV, psychopathy is an empirical construct commonly measured with the Psychopathy Checklist-Revised (PCL-R) with affective-interpersonal and social-deviant dimensions, each of which is predictive for a variety of behaviors, including types of aggression. Differences between them include focus on objective behavioral criteria in case of antisocial disorder, its greater representation in the forensic population, and the fact that psychopathy is better in predicting deviant acts and criminal recidivism. The highest diagnostic overlap is with drug addiction and narcissistic personality disorder, while antisocial disorder also shows higher comorbidity with other psychiatric diagnoses. Epidemiological studies suggest a higher prevalence of antisocial disorder in the general population, and there are also gender differences in the intensity of psychopathic traits, which is expected from personality psychology perspective. Etiological empirical studies have a rich tradition in case of psychopathy, which includes findings of broader genetic predispositions interacting with environmental stressors, specific deficits in emotional and cognitive functioning, neuroanatomical and neurophysiological abnormalities, and broader cultural factors. Although there are some indications of positive changes in antisocial and psychopathic patients, psychotherapeutic and pharmacological treatments have not been systematically studied and generally do not result in long-term clinical progress. Finally, it seems that future diagnostic classifications of personality disorders will include both dimensions of psychopathy.


My ten-year experience in work with individuals with intellectual disabilities has made me aware of the need of more extensive activities to improve their health care with special reference to mental health care. It has resulted in the development of Project, a plan of various activities that are necessary to upgrade the overall care for persons with intellectual difficulties. The plan has been commented and amended in consultation with professionals from the School of Special Education and Rehabilitation, then with Prof. Ante Došen, PhD and Martin van den Berg, MD, during my stay at de Swaai in Beetstezwaag, The Netherlands. In line with the Project schedule, the Croatian Society for Mental Health of Individuals with Intellectual Disabilities of the Croatian Medical Association will be founded in May 2010, whereas the second half of the year will be focused on providing material preconditions for the multidisciplinary team full-time work at the Center for Mental Health of Individuals with Intellectual Disabilities and Autism, planned to start working at University Department of Psychiatry, Zagreb University Hospital Center at the beginning of 2011.


Articles published in the journal Socijalna psihijatrija during the 2001-2011 period were analyzed in order to determine the main characteristics of the articles (categorization, narrow field of interest, authors and affiliating institutions). Key words were analyzed according to their frequency and fields. The References section was also included in the analysis. During the study period, 386 papers including 331 articles and 55 editorials, book reviews, news, etc.) appeared in the journal. According to article category, professional papers prevailed (n=123). Topics in the fields of clinical psychiatry, psychotherapy, social psychiatry, and pediatric and adolescent psychiatry were most frequently tackled. There were 1058 authors or actually 452 persons in total. The analysis of authors revealed psychiatrists, psychologists and psychiatry residents to predominate, while university departments of psychiatry and psychiatric hospitals were their most common affiliation institutions. Concerning key words, those in the field of clinical psychiatry, psychotherapy, and pediatric and adolescent psychiatry were most commonly used. Results obtained in the study were compared with those recorded a decade before in another analysis of the articles published in Socijalna psihijatrija during the 1991-2000 period.

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