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Mustapic M.,Ruder Boskovic Institute | Popovic Hadzija M.,Ruder Boskovic Institute | Pavlovic M.,Institute for Medical Research and Occupational Health | Pavkovic P.,University of Zagreb | And 6 more authors.
Metabolic Brain Disease | Year: 2012

Type 2 diabetes (T2D) and Alzheimer's disease (AD) are two progressive disorders with high prevalence worldwide. Polymorphisms in tumor necrosis factor-alpha (TNF-a) and apolipoprotein E (ApoE) genes might be associated with both T2D and AD, representing possible genetic markers for the development of the AD in subjects with T2D. The aim was to determine ApoE and G-308A TNF-a gene polymorphisms in unrelated Croatian Caucasians: 207 patients with sporadic AD, 196 T2D patients and 456 healthy controls. Patients with AD had higher frequency of ApoE4 allele compared to T2D patients and controls. The significant association, observed between ApoE2 allele and T2D, disappeared after the data were adjusted for age and sex. The genotype or allele frequencies of G-308A TNF-a gene polymorphism were similar among the patients with AD, T2D and healthy controls. In conclusion, these results do not support the hypothesis that the A allele of G-308A TNF-a gene polymorphism is associated either with AD or T2D. Our data confirm the association between the ApoE4 allele and AD, and point out the E2 allele of ApoE gene as the possible risk factor for T2D. © Springer Science+Business Media, LLC 2012. Source

Mimica N.,Psychiatric Hospital Vrapce | Mimica N.,University of Zagreb | Presecki P.,Psychiatric Hospital Sveti Ivan
Psychiatria Danubina | Year: 2010

The current clinical view on pharmacological treatment and the Croatian reality regarding approved antidementia drugs is presented. Dementia is a syndrome of high incidence and Alzheimer's disease is the most common cause of dementia. New data show that dementia prevalence will nearly double every 20 years, and we believe that current estimated number of persons with dementia (PWD) for Croatia is more than 80,000. The standard treatment with antidementia drugs is unavailable in Croatia, for the majority of PWD, because antidementia drugs are not on the reimbursement list, although Croatian algorithm for psychopharmacological treatment and Alzheimer Disease Societies Croatia recommend early and adequate treatment. Alzheimer's dementia is becoming a world's health priority in 21st century, so we strongly believe that antidementia drugs should be reimbursed in Croatia. © Medicinska naklada. Source

Zivkovic M.,Neuropsychiatric Hospital Dr. Ivan Barbot | Mihaljevic-Peles A.,University of Zagreb | Sagud M.,University of Zagreb | Silic A.,Psychiatric Hospital Sveti Ivan | Mihanovic M.,Psychiatric Hospital Sveti Ivan
Psychiatria Danubina | Year: 2010

Malignant neuroleptic syndrome (MNS) is a serious and potentially fatal side-effect of neuroleptic treatment. Beside antipsychotic drugs, other psychotropic drugs such as antidepressants and lithium carbonate can cause this life threatening side-effect. Underlying mechanism of this side-effect is still unknown and debated. So far some risk factors have been identified, with clinical observations and recent pharmacogenetic research suggesting (with inconsistent findings) correlation between genetic mechanisms and predisposition to MNS. Polymorphisms of CYP2D6 enzyme through which most psychotropic drugs are metabolized and TaqIA DRD2 which is target for antipsychotic drugs could be the link between pharmacogenetic factors and potential for development of MNS. In this paper we present two case reports with clinical presentation of three consecutive MNS. One patient developed MNS while he was taking combination of drugs: first time haloperidol, promazine and fluphenazine, second time fluphenazine and perazine and third time clozapine, promazine and valproic acid consecutively. The other patient developed MNS while taking following combination of drugs: first time haloperidol and lithium carbonate, second time risperidone and third time clozapine consecutively. Pharmacogenetic analysis for CYP2D6 and TaqI A DRD2 polymorphisms for both patients was done. Genotypisation of CYP2D6*1*3*4*5*6 in both patients showed no evidence of poor metabolizer phenotype. On the other hand, first patient was heterozygous for CYP2D6*4 (genotype*1/*4). CYP2D6 polymorphisms could have clinical significance because may lead to toxicity and unwanted side-effects in standard usual antipsychotic dose ranges. Analysis Taql A DRD2 polymorphism for first patient showed that he is heterozygous for A1 allele (genotype A1A2) which is commonly associated with predisposition to MNS. According to our literature three consecutive MNS are rarely described, and incidence of MNS generally is too low to perform clinical research. Many patophysiological mechanisms may probably underlie this complex and potentially fatal syndrome, still unknown etiology. But, genetic mechanisms could be significant. Further pharmacogenetic research, findings and analysis in patients who develop single or repeated MNS are strongly recommended. In long term, pharmacogenetic analysis, implemented in daily clinical practice, could help in prevention of this extremely serious side-effect. © Medicinska naklada. Source

Jaksic N.,University of Zagreb | Brajkovic L.,University of Zagreb | Ivezic E.,Psychiatric Hospital Sveti Ivan | Topic R.,University of Zagreb | Jakovljevic M.,University of Zagreb
Psychiatria Danubina | Year: 2012

Background: A number of studies have shown that although exposure to potentially traumatic events is common, development of PTSD is relatively rare, which is one of the reasons PTSD still remains a controversial psychiatric entity. The aim of this article was to provide an overview of the research on the role of personality traits in the vulnerability, resilience, posttraumatic growth and expressions associated with PTSD. Personality based approach represents a dimensional aspect of the transdisciplinary integrative model of PTSD. Methods: We conducted a systematic search on PubMed, PsycINFO, and Academic Search Complete from 1980 (the year PTSD was first included in the DSM) and 2012 (the year the literature search was performed). Manual examination of secondary sources such as the reference sections of selected articles and book chapters were also conducted. Results: Most of the reviewed studies dealing with personality traits as vulnerability and protective factors for PTSD examined the relationship between basic personality dimensions and severity of symptoms of PTSD. These studies have applied three types of methodological designs: cross-sectional, post-trauma and pre-trauma longitudinal studies, with latter being the least common option. Conclusion: Finding that appears relatively consistent is that PTSD is positively related to negative emotionality, neuroticism, harm avoidance, novelty-seeking and self-transcendence, as well as to trait hostility/anger and trait anxiety. On the other hand, PTSD symptoms are negatively associated with extraversion, conscientiousness, self-directedness, the combination of high positive and low negative emotionality, as well as with hardiness and optimism, while posttraumatic growth shows inverse relation to most of these traits. Furthermore, a number of studies have confirmed the existance of three distinct personality-based subtypes of PTSD: internalizing, externalizing and low pathology PTSD. These findings may help in further uncovering etiological mechanisms and in building new strategies for prevention, identification and reduction of health risks among this trauma population, as well as facilitating potential posttraumatic growth. However, focusing on just a single dimensional perspective will unable us to generate comprehensive knowledge of the etiology, course and treatment of PTSD. © Medicinska naklada. Source

Presecki P.,Psychiatric Hospital Sveti Ivan
Psychiatria Danubina | Year: 2010

Idiosyncratic reactions are serious, unpredicted adverse effects of antiepileptic drugs which are in use in psychiatry as mood stabilizers. Severe idiosyncratic reactions can manifest as systemic symptoms or Dress syndrome clinically manifested with increased body temperature, peripheral lymphadenopathy and potential one or multiple organ failure. We present a 36 years old patient, who was hospitalized for the first time in our hospital after he attempted suicide by hanging. Patient was diagnosed as Bipolar affective disorder, current episode depressive with psychotic features and high suicidal risk. At the time of admission he was taking olanzapine and venlafaxine. Psychopharmacs were cross titrated to clozapine, valproic acid and lamotrigine. Two weeks later, patient's mood was stabilized but his somatic status worsened dramatically. He was forwarded to Clinic for Infective Diseases where he was diagnosed with severe sepsis. Dress syndrome, although initially suspected was not verified, but has to be taken into consideration in each patient prescribed with antiepileptic drugs. Source

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