ENGRAMI su časopis za kliničku psihijatriju, psihologiju i granične discipline. Osnovan je 1979. godine. ENGRAMI se izdaju kroz dve sveske godišnje. Časopis objavljuje: saopštenja urednika, originalne radove, meta-analize, preglede iz literature, preliminarna ili kratka saopštenja, radove za praksu, stručne vesti, radove iz istorije psihijatrije, psihologije i graničnih disciplina, eseje vezane za stručno mišljenje, članke koji prikazuju lična gledišta, akutelne teme, komentare po pozivu, prikaze knjiga i dopise za rubrike Sećanje, In memoriam i Promemoria, kao i komentare i pisma Uredništvu u vezi s objavljenim radovima
Univerzitetski klinički centar Srbije , Klinika za psihijatriju, Beograd i Udruženje psihijatara Srbije, Beograd
Reasons Why Risperidone and Paliperidone Should Not Be Regarded as the Same Drug
Risperidone and paliperidone are often regarded in clinical practice as closely related, almost interchangeable antipsychotics, primarily because paliperidone, i.e. 9-hydroxy-risperidone, is the main active metabolite of risperidone. This perception of equivalence has led to the widespread use of the concept of the “active moiety,” which refers to the sum of risperidone and 9-hydroxy-risperidone concentrations in blood. Although this concept is useful for therapeutic drug monitoring, it does not imply pharmacological identity between the two molecules. Available data indicate that risperidone and paliperidone differ in their receptor profile, affinity for the dopamine D2 receptor, balance between serotonergic and dopaminergic activity, passage across the blood–brain barrier, and dependence on CYP2D6 metabolism. In addition, the long-acting injectable formulations of risperidone and paliperidone have different pharmacokinetic principles, which further complicates simple dose conversion. This paper discusses the pharmacological and pharmacokinetic reasons why risperidone and paliperidone should not be regarded as the same drugs, but rather as very closely related therapeutic options that may differ in many clinical situations. Special emphasis is placed on the importance of individualizing treatment based on blood drug concentrations, the ratio between risperidone and 9-hydroxy-risperidone, CYP2D6 genetic status, adverse effects, and the choice between oral and long-acting formulations.
Synergy Between Selective Serotonin Reuptake Inhibitors and α2-Adrenergic Receptor Antagonists in the Treatment of Depression
Selective serotonin reuptake inhibitors (SSRIs) represent the most commonly used pharmacotherapeutic strategy in the treatment of major depressive disorder. However, a substantial proportion of patients do not achieve remission, develop only a partial response, or remain burdened by residual symptoms, most commonly insomnia, anxiety, loss of appetite, sexual dysfunction, and gastrointestinal complaints. Combining SSRI antidepressants with α2-adrenergic receptor antagonists, among which mirtazapine is the most important clinical representative, is a pharmacologically rational approach because it simultaneously enhances serotonergic transmission through complementary mechanisms and adds a noradrenergic component to antidepressant action. While SSRIs increase the synaptic availability of serotonin by inhibiting the serotonin transporter, mirtazapine increases the release of noradrenaline and serotonin by blocking presynaptic α2-autoreceptors and α2-heteroreceptors. In addition, antagonism of 5-HT2 and 5-HT3 receptors functionally directs serotonergic transmission toward 5-HT1A-mediated effects and may contribute to better tolerability compared with pure serotonergic potentiation. The clinical significance of this combination is most evident in patients with a partial response to SSRIs, depression accompanied by insomnia, anxiety, loss of appetite, or adverse effects of SSRI therapy. However, although randomized studies and meta-analyses generally indicate greater efficacy of combinations that include α2-receptor antagonists, some studies, such as the MIR trial, did not demonstrate a significant benefit of adding mirtazapine to ongoing SSRI therapy in all patients with SSRI-resistant depression. Therefore, the combination of an SSRI and mirtazapine should be regarded as a personalized, symptom-guided, and pharmacologically grounded strategy, rather than as a universally superior therapeutic approach.
EnglishWhen Compassion Becomes a Threat: Reasons for Clients’ Resistance to Therapeutic Support
Compassion represents one of the most significant components of the therapeutic relationship. It can be defined as a basic caring attitude, involving deep awareness of one’s own and others’ suffering, accompanied by the desire and efforts to alleviate it. The aim of this paper is to examine the contributing factors and effective strategies for managing fears, psychological blocks, and resistances that prevent clients from receiving care and compassion from the therapist, approached primarily from the perspective of Compassion-Focused Therapy. The paper focuses on clients who have experienced childhood trauma and who therefore often struggle to receive or accept therapeutic support due to the deep impact of trauma on trust, attachment, and core beliefs about others. We will first discuss the concept of compassion, followed by an examination of the various barriers to its development, including clients’ beliefs that they do not deserve care and warmth, doubts about the therapist’s intentions, and fears of their own emotional vulnerability. We will also present strategies for overcoming fears, blocks and resistance to compassion, which include: developing a compassionate relationship within the therapeutic environment, psychoeducation on the function of compassion, working on beliefs that block compassion, cultivating physiological calmness and grounding in the present moment, compassionate imagination and working with shame and early developmental trauma. Understanding and validating resistance are not obstacles but essential parts of the therapeutic process, enabling the client to gradually develop the capacity and willingness to accept warmth and care from others. Working through resistance within therapy creates space for developing the ability to extend compassion to oneself and others, thereby improving emotional regulation.
Sleep disorders in pregnancy and postpartum
Sleep disorders are highly prevalent during pregnancy and the postpartum period and arise as a consequence of complex hormonal, anatomical, neurobiological, and psychosocial changes. Among primary sleep disorders, insomnia, obstructive sleep apnea, restless legs syndrome, and parasomnias are most commonly present in the perinatal period, and these conditions are associated with significant adverse maternal and fetal outcomes. The relationship between sleep and perinatal psychiatric disorders is often bidirectional: sleep disturbances may represent an early symptom, a risk factor, and a pathophysiological driver of depression, anxiety disorders, bipolar disorder, and postpartum psychosis, as well as other primary psychotic disorders. This paper reviews clinically relevant primary sleep disorders, the principles of their treatment, and the management of sleep disturbances occurring within other psychiatric disorders during the perinatal period.
Irritability in children and adolescents: Contemporary perspectives and clinical implications
Although pathological irritability has long been studied, intensive research in the last twenty years has brought significant findings about its etiology and potential therapies. This overview gives the current understanding, diagnostic aspects, neuropsychobiological characteristics and treatment of irritability in children and adolescents. Irritability is understood today as an increased tendency to anger that manifests itself stably over time. Although not a disorder, irritability is a cardinal symptom of oppositional defiant disorder with chronic irritability-anger. It is also present as an associated symptom in various internalizing and externalizing disorders, and is especially associated with depression, anxiety disorders, autism, and attention deficit hyperactivity disorder (ADHD). It is assumed that it arises due to reduced tolerance to frustration and a lowered threshold for the perception of external stimuli as threatening, as well as being a hereditary feature significantly dependent on environmental influences. Treatment is based on pharmacological, non-pharmacological and combined treatments, whereby second-generation antipsychotics are proven to be the most effective. A broader understanding of irritability as a complex transdiagnostic, psychopathological phenotype of mood, cognition and behavior, and a common denominator of various disorders, has important clinical implications, especially for early recognition, correct diagnosis and effective treatment.
Theory of Mind in Schizophirena from the Perspective of the Phenomenological Philosophical Tradition
Human consciousness is "anchored" in the body (embodied). At the same time, humans are social beings. In the language of the phenomenological philosophical tradition, we are "immersed" in relationships with others. Accordingly, our understanding of other people's feelings is not solely a result of internal cognitive processes. Instead, we experience others' feelings through a shared, bodily-mediated experience of the world. Reconceptualizing empathy as a bodily phenomenon and recognizing the role of interaffectivity in mediating social interactions provides a new direction for understanding empathy in individuals with schizophrenia. Such an approach enables a richer and more nuanced interpretation that integrates both cognitive and bodily dimensions of human experience, opening possibilities for more effective interventions and improvement of social functioning in individuals with schizophrenia.
Pro memoria: Timothy Crow – departure of the pioneer of evolutionary psychiatry
HORROR GENRE IN LITERATURE AS A MEANS FOR EXPLORING THE COLLECTIVE UNCONSCIOUS
The horror genre aims to evoke specific emotions (such as fear) in its audience through the literary form, connecting with the deeper layers of the collective unconscious. The purpose of this paper is to analyze and interpret the horror genre through the prism of Carl Gustav Jung's theory of the collective unconscious. Horror, as a genre in literature and film, can be viewed in the context of literary, psychiatric, psychological, and philosophical disciplines. Through a detailed analysis of classic works of this genre, such as "Dracula" and "Frankenstein", and other horror stories, the paper explores the ways in which elements of fear, horror, and the irrational act as projections of archetypal symbols and motifs, which are integral parts of the collective unconscious. The paper also discusses the influence of culture and social norms on the formation and interpretation of these archetypal elements. Additionally, the paper considers the concept and mechanism of catharsis, and the manner in which the horror genre uses language and style as means to create atmosphere and deeper emotional impact on the reader. In conclusion, it summarizes the fact that the horror genre serves not only for entertainment and inducing fear but also as a means for a deeper understanding of the complexity of human psychology and the collective unconscious. Through analysis and interpretation, the paper highlights the potential of the horror genre as a tool for exploring and understanding human nature and fears, desires, and conflicts that transcend individual differences and cultural contexts.
Identity Capital in Serbian Youth: A Pilot Study
In our study comprising 522 emerging adults we have tried to determine the level of integration in adult society and the variables that contribute to this that are described in the identity capital model based on Erikson’s lifelong development theory. We have found that a highly significant percentage of variance is determined by certain personality characteristics such as self-esteem and locus of control, and by identity variables such as commitment making, identifying with commitment, exploration in breadth and exploration in depth. Negative outcome identity variables such as ruminative exploration do not have any significant influence on the model. While examining previous studies we can make a case that as the increase in age of young adults that participate in the study increases the influence of identity variables on the model.
Differences in symptoms of depression in comparison to the course of diabetes with diabetic foot complications
Introduction: Diabetes is a significant global health challenge, with increasing prevalence worldwide. The poorly understood relationship between physical complaints and mental health, manifested through associated depressive symptoms in people with diabetes, has attracted considerable attention in recent years. The aim: To examine the relationship between the presence of depressive symptoms and diabetic foot complications in people with diabetes. Method: The study used a retrospective-prospective design and was conducted in the period from October 15, 2023. until 15.02.2024. years. A total of 87 subjects with diabetes were included, who were categorized into three groups based on the presence of diabetic foot complications - diabetic ulcer. The first group consisted of patients with diabetic foot and ulcer treated by amputation (DS/A) (n = 29), the second group consisted of patients with diabetic foot and ulcer treated conservatively (DS/K) (n = 30), and the third the group consisted of patients with diabetes who did not have a diabetic foot (DS-cont) (n = 28). By examining the medical records, the following data were collected: age, sex, number of comorbid diseases, duration of the disease in years. All patients completed the PHQ-9 questionnaire to assess depressive symptoms. Results: Patients from the DS/Amp group had significantly higher PHQ-9 scores compared to patients from the DS/K and DM-cont groups. Linear regression analysis identified group affiliation as a significant predictor of increased PHQ-9 scores. Conclusion: People with diabetic foot amputations show higher levels of depressive symptoms. Further prospective studies are needed to clarify the cause-and-effect relationship between the presence of depressive symptoms and diabetic foot complications. Keywords: diabetic foot, depressive symptoms, amputations, comorbidity.
The therapeutic relationship - an analytical perspective
The most significant factor in therapeutic change is the therapeutic relationship. In this paper, we will consider the specifics of the therapeutic relationship from the perspective of analytical or Jungian psychotherapy. First, we will briefly explain the characteristics of the therapeutic relationship in the classical, archetypal and developmental school of Jungian psychotherapy. We will connect the psychotherapy process with the concept of individuation and in that context we will explain the analytical approach to the symptom as a crisis in the individuation process. Various viewpoints on transference will be presented, from the development of Jung's original ideas to the latest viewpoints on the nature and use of transference and countertransference in therapeutic work. In particular, we will consider the concept of the wounded healer. We could understand this constellation as an archetypal basis for establishing an analytical relationship. Guggenbuhl-Craig extended the concept of the "wounded healer" to the field of all helping professions. This archetype has two poles; the first is manifested through health, power, ability, while the second pole of this archetype is manifested through weakness, illness, passivity, incapacity, dependence. It often happens that only one pole is associated with the role of doctor and psychotherapist. The second pole of the archetype – weakness and illness – is related to the role of the patient. And in fact, the therapist, just like the client, carries within him the potentials of both opposite aspects -health and illness. The wounded healer understands and heals precisely his wound, which never completely heals and represents a common field of experience for both the therapist and the client. We can also understand the recovery process as the process of activating the "inner healer" in our patients. After completion of the therapeutic process, they rely on their inner potential for healing and recovery, which is not only a result of the introjection of the therapist and the therapeutic relationship, but also has its archetypal basis.
Vladeta Jerotić – A Legacy of Personal and Professional Influence
Pro Memoria – A Centenary of Vladeta Jerotić's Birth
Virtual reality and assessment of neurocognitive functions
Virtual reality and assessment of neurocognitive functions The expansion of technology over the past twenty years has led to the digitalization of psychological assessment tools and the development of new evaluation techniques, with virtual reality (VR) standing out in terms of clinical utility. VR involves temporarily suspending contact with reality and placing a person in a simulated, experimentally controlled situation that resembles a real environment. Immersion in digital reality can be either complete or partial, a dimension that depends on the technological characteristics of the virtual system and affects psychological processes and the participant's experience during the assessment process. Instead of traditional paper-and-pencil tests, the virtual environment represents a completely new medium and experimental situation that we have not previously encountered, generating a wealth of ideas in psychology. Research often investigates the ecological validity or convergent validity between psychological tests and situations created in VR, particularly with groups of individuals with dementia and schizophrenia. Executive functions are typically the focus of measurement, and there is particular interest in the potential of VR-based assessment to enable early detection of cognitive impairments in healthy individuals. The paper discusses the advantages of VR over traditional neuropsychological tests, as well as its drawbacks, particularly the phenomenon of virtual reality sickness, which limits the duration of testing and reduces the validity of measurements. It is already evident that VR techniques will be implemented into psychological test batteries to increase the sensitivity and ecological validity of neuropsychological assessments, and recommendations will be provided on how VR can be clinically utilized in the rehabilitation and therapy of cognitive functions. Key words: virtual reality, neurocognitive functions, neuropsychological assessment
This paper presents achievements in the application of innovative technologies in the field of psychiatry. Technologies such as artificial intelligence (AI), machine learning, telepsychiatry and digital therapy tools have significantly changed the approach to diagnosis and treatment of mental disorders. The paper analyzes the advantages, challenges, and ethical implications of the use of these technologies, and explores their impact on the future of psychiatry.
Pathological social withdrawal syndrome and the paradox of new technologies
The concept of the "Fourth Industrial Revolution" highlights its transformative impact on industries and society through technologies like artificial intelligence and robotics, which blur the lines between the physical, digital, and biological realms. This extends into the psychological realm, prompting questions about our ability to adapt to rapid technological changes. "Hikikomori" (Japanese) or pathological social withdrawal, a condition, characterized by an extreme form of social isolation, was first recognized in Japan. While initially seen as culturally specific, hikikomori has become a global issue. Early developmental factors such as family dynamics and later environmental factors and stressors contribute to this condition, while the role of technology, including increased internet use, is not completely clear. We explore here the relationship between technological advances and pathological social withdrawal and the hypothetical dual role of these advances- promoting isolation on one hand, and offering potential therapeutic benefits on the other.
Book Review: „Vedrina psihijatrije i njeni otmičari“ (eng. The Serenity of Psychiatry and Its Kidnappers)
The new book, „Vedrina psihijatrije i njeni otmičari“ (eng. The Serenity of Psychiatry and Its Kidnappers), authored by Dr. Saša Branković, represents a valuable and authentic contribution to contemporary discussions on psychiatry and mental health. The author analyzes the loss of psychiatry’s optimistic narrative and humanistic essence—the transformation of a highly sophisticated, creative discipline once attentive to patients’ individual specificities into an impersonal, reductionist system that frustrates both those who are treated and those who provide treatment. Nevertheless, Branković simultaneously offers hope and guidance for restoring psychiatry as an authentic discipline devoted to the human being, reminding us that the essence of medicine must not be reduced to mere technical procedures but should remain oriented toward preserving dignity, health, and humanity. The work carries a strong humanistic message, emphasizing that integrity, knowledge, and courage are the foundations of genuine medical practice.
Effects of psychedelics on brain plasticity – a review of current research and the possibility of therapeutic use in psychiatry
Psychedelics are psychoactive substances that cause changes in perception, state of consciousness, mood and numerous cognitive processes. The best known are lysergic acid diethylamide (LSD), N,N-dimethyltryptamine (DMT), psilocybin and mescaline. The main mechanism of action of psychedelics is agonism towards serotonin 5-HT2A receptors. In the middle of the 20th century, interest in the use of psychedelics in psychiatry arose, but due to political pressure and the potential danger of uncontrolled use, they were banned in the 1970s. In the absence of innovations in treatment and new psychopharmacological agents, the potential of psychedelics in the treatment of mental illnesses has again been the focus of research in recent decades. In this paper, the neurobiology of psychedelics will be presented in the light of current research on their effects on neural networks and neuroplasticity, and therefore the possibilities of therapeutic application in psychiatry. Also, recent research will be presented with an emphasis on randomized double-blind placebo-controlled studies in which the effectiveness of the use of psychedelics in the treatment of depression and disorders caused by the use of alcohol and other psychoactive substances was examined. Findings so far indicate that psychedelics may be a promising new approach for the treatment of mental illness, but the use of psychedelics for these purposes raises not only bioethical, but also new legal issues.
Long-acting second-generation antipsychotics : challenges and benefits of available treatments
Long-acting injectable antipsychotics were developed in the second half of the twentieth century as an important element in the deinstitutionalization process of psychiatric patients. Today, their role is significant in improving compliance, achieving stable drug concentrations in plasma, preventing relapses, and enhancing cognitive functioning in chronic patients. Although several long-acting second- and third-generation antipsychotic preparations have been registered over the past two decades, only four preparations are currently registered in our region: long-acting risperidone microspheres and in situ microparticle-based (ISM) formulations; paliperidone palmitate formulations for one and three months. This review aims to present their pharmacokinetics and pharmacodynamics, clinical efficacy, side effects, and challenges in titration and interchangeability of these preparations. Keywords: long-acting antipsychotics; risperidone microspheres; risperidone ISM; paliperidone palmitate.
Phenomenological psychiatry and literature: guardians of the “lifeworld”
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Priority="49" Name="List Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> This paper explores the deep parallels between phenomenological psychiatry and the modern novel, arguing that both disciplines act as “guardians” of the lived world (Lebenswelt) against the reductive tendencies of modern scientism. Drawing from phenomenological psychiatry – particularly the work of Jaspers, Minkowski, Binswanger, Fuchs, Sass, and Parnas – and literary modernism as articulated by Kundera and others, I show how both psychiatry and literature illuminate the subtle textures of subjective experience, including temporality, embodiment, and intersubjectivity. Literary modernism, exemplified in the works of Kafka, Woolf, Proust, and Kundera, not only anticipates but extends the phenomenological exploration of disturbances in these experiential structures, such as those seen in depression, schizophrenia, and trauma. By juxtaposing phenomenological psychiatry’s clinical accounts with literary portrayals, the paper reveals how the novel’s narrative imagination offers “eidetic” insights into lived experiences that exceed positivist, objectifying models of mind. The analysis extends to Serbian and Yugoslav literature, showing how authors such as Petrović, Kiš, Crnjanski, Pavić, Pekić, and Živković have crafted intricate narratives that align with phenomenological psychiatry’s emphasis on the relational and historical embedding of subjectivity. Ultimately, this comparative analysis argues that both literature and phenomenological psychiatry fulfill an indispensable role: to safeguard and deepen our understanding of the lived world in an era dominated by abstraction and reductionism.
IN MEMORIAM Prim. dr sci. med. Živorad Kastratović
RETRACTION: State of the art and new frontiers in sleep research: New qualitative and quantitative approaches (Engrami, 2002: 24(2), 62-73)
Based on the fact that journal ENGRAMI is indexed in Serbian citation index SCIndeks, which provides journal a check of the manuscript, we are informed that based on subsequent, retroactive manuscript checking on the presence of plagiarism by means of CrossRef/iThenticate service, a violation of academic ethical principles was found. The paper entitled: State of the art and new frontiers in sleep research: New qualitative and quantitative approaches by authors Ilanković N. and Ilanković A. (https://scindeks.ceon.rs/article.aspx?artid=0351-26650202062I) which is published in the journal ENGRAMI (2002): 24(2) (pp. 62-73) presents the (auto)plagiate (extensive use of the text published in the previous papers without quoting the original) of the articles: Ilanković N, Draganić S and Ilanković A. EEG and the sleep disorders. in: Ilanković N, Ilanković V. i Jašović-Gašić M. (eds). Bolesti spavanja dijagnostika i lečenje (Cibif, 1995): 79-96. Ilanković N and Ilanković AN. EEG and the Sleep Disorders: a new quantitative approach. In: Brain and Consciousness. Proceedings of the First Annual ECPD International Workshop on Scientific Bases of Consciousness. (Belgrade, 1997, Čigoja štampa), pp. 117-128. Moreover, paper “State of the art and new frontiers in sleep research: New qualitative and quantitative approaches” published in Engrami, 2002 was almost identical with the later publication: Ilanković N, Ilanković A, Ilanković V. New Hypothesis and Theory about Functions of Sleep and Dreams. Macedonian Journal of Medical Sciences. 2014 Mar 15; 7(1):78-82. The authors approached inadequately the quotation and citation of sources and thus acted contrary to the ethical code of scientific research, grossly violating the editorial policy of the journal ENGRAMI and Committee for Ethics of Publication principles. Bearing in mind a violation of ethical principles relating to a multiple submissions from 1995 to 2014, the editorial board of the journal ENGRAMI made a retraction of the paper.
Antidepressants and COVID-19: case report and literature review
Introduction. Anti-inflammatory potential of antidepressants was observed before the COVID-19 pandemic. However, it recently regained spotlight when studies with large number of patients showed that antidepressants reduced the risk of intubation and death in COVID-19 symptomatic infection. Also, the response to antidepressants seems to be more rapid in post-COVID depression that in non-COVID19 related depression. The aim of this paper to review the literature regarding the effects and mechanisms of action of antidepressants in COVID-19 infection and post-COVID sequalae, and to present a case repot of a typical outpatient with post-COVID depression. Conclusion. Post-COVID depression is a common sequela of COVID-19 infection. Selective serotonin reuptake inhibitors elicit a rapid and efficient response in patients with post-COVID depression, which may be explained by their anti-inflammatory properties. Timely screening and treatment of post-COVID psychiatric disorders can significantly decrease the burden of COVID-19 pandemic both at the individual and societal level. Also, it is discussed how the pandemic studies of antidepressant mechanisms of actions provided new insights on the aetiology of depression.
LEUKOPENIA AS THE ONLY SYMPTOM OF COVID-19 IN PATIENTS WITH SCHIZOPHRENIA ON CLOZAPINETHERAPY
Patients suffering from Covid-19 often have leukopenia, most often lymphopenia, as an accompanying laboratory manifestation of the clinical syndrome, but there are indications that at the beginning of the disease they also have mild neutropenia. Clozapine can have hematological side effects in terms of leukopenia - most often neutropenia. The paper presents a patient with schizophrenia who is on long-term clozapine therapy. At the time when leukopenia was detected in the blood count, he was mentally stable and physically asymptomatic. He had a reduced number of leukocytes as the only symptom of infection with the new coronavirus SARS CoV 2, which we confirmed by PCR. In this paper, we present the clinical picture of Covid-19 in connection with the possible overlapping etiology of leukopenia, which can also appear as a separate symptom of infection with the SARS CoV 2 coronavirus and be a hematological side effect of clozapine treatment.
Karl Jaspers: a portrait of a philosopher–psychiatrist
Karl Jaspers was a philosopher and a psychiatrist. He made numerous contributions to both disciplines during his lifetime. The most significant contribution within psychiatry was the introduction of the phenomenological method and the creation of phenomenological psychopathology, which forms the basis of the psychopathological assessment. Moreover, he introduced the distinction between explanation and understanding into psychopathology, thus enriching our conceptual knowledge. By clarifying these concepts, Jaspers helped our strivings towards perceiving the patient as a person, instead of an object waiting to be analyzed. As a philosopher, a “neo-Kantian”, within his philosophy of existence he developed numerous insights, especially highlighting so-called limit-situations. Limit-situations include experiences such as: death, suffering/struggle, randomness, and guilt. Such situations touch the limit of experience and point to what is transcendental, while at the same time, opening up possibilities for the realization of one’s own authenticity. This paper highlights Jaspers’ most significant contributions and describes Jaspers’ professional development, while also describing some elements of his personality and upbringing.
AFFECTIVE TEMPERAMENTS IN MENTAL HEALTH AND MOOD DISORDERS
Temperament includes genetic-biological components of behavior that include mood, the way of emotional reaction in terms of speed, intensity, duration and type of reaction, relationship to the environment, and sensitivity to external stimuli. Attempts to classify temperaments date back to the time of Ancient Greece, while the modern concept of temperament is based on the work of Kraepelin and Kretschmer. Hagop Akiskal continued the development of the modern concept of temperament and divided the types of affective temperaments into: depressive, hyperthymic, cyclothymic, irritable and anxious temperament. In a healthy population, temperament represents an important, biological, basis of personality. However, dominant affective temperaments are thought to potentially lie on a continuum between healthy emotional reactivity and affective disorders. Also, dominant affective temperaments in an accentuated form can represent subclinical manifestations of affective disorders, as well as precursors for the emergence of these disorders. Based on strong genetic and neurochemical foundations, affective temperaments have developed and persisted throughout evolution because they carry distinct evolutionary and social advantages. Thus, in addition to pathological, temperamental characteristics can also have an adaptive value. Additional research on understanding of affective disorders as a continuum as opposed to their categorical classification, with respect for the transitional forms they take from mental health to mental disorders, would contribute not only to a better understanding of the emotional life of a man, but also to timely, targeted and better treatment of various psychopathological forms.
Enactive framework for psychiatric disorders
The paper shows how enactivism can be used as a theoretical framework in psychiatry. An enactive approach can help solve the problem of integration in psychiatry and how to meaningfully connect the different perspectives with which we explain the causes and nature of psychiatric disorders. Enactivism allows us to comprehensively connect the phenomenological, neurophysiological, sociocultural, and existential aspects of psychiatric disorders and holistically approach their understanding and treatment. I will explain what the tenets of enactivism are, what the problem of integration in psychiatry is, and how, according to Saneke de Haan, we can provide a solution to this problem through the enactivist approach. Finally, I will suggest how enactivism can be enriched by adding an ecological perspective.
Prevalence of Depression Among Staff at the City Institute for Emergency Medical Services Belgrade
Introduction: According to the WHO, depression is a common mental disorder where workplace conditions play a significant contributing factor. Objective: To examine the prevalence of depression and the relationship with sociodemographic characteristics in staff at the Institute for Emergency Medical Services (EMS) Belgrade, i.e., physicians, medical technicians, drivers and administrative workers. Methodology: The research was conducted at the City Institute for EMS Belgrade in the period from December 1 to December 6, 2007. The questionnaire consisted of questions about the sociodemographic characteristics of participants, a self-assessment questionnaire for depression PHQ-9 and a question about the use of antidepressants. The data that was collected was statistically processed with the software package SPSS 20.0 Results: The study included 118 participants, 58.47% were male and the average age was 40.77 ± 8.86. The result of the PHQ-9 test showed that 30% of the participants had subsyndromal depression, 11% had a mild depressive episode, most often in female participants (p = 0.023) and in administrative workers (p = 0.003). Depression was present in 16.95% of respondents. Out of the 9 listed symptoms of depression, fatigue/extreme exhaustion were most commonly present (47.46%) as well as feelings of emptiness and hopelessness (43.22%). Only 11.86% of participants used antidepressants and there was no statistically significant difference in relation to the observed parameters. Conclusion: Subsyndromal depression is significantly present among the EMS staff in Belgrade, more often among female participants and those working in administration.
Preliminary psychometric investigation of Serbian Mindful Attention and Awareness scale (MAAS) and potential role of Mindful Attention and Awareness in behavioral regulation among students
Introduction: Recent studies about Mindful Attention and Awareness elucidated its potential role in affective difficulties and behavioral regulation, but authors call for further investigation of potential underlying mechanisms. Research goal: The current study was conducted in order to examine the preliminary psychometric properties of the Serbian Mindful Attention and Awareness scale, its relationship with positive psychological constructs, along with its mediating role in the relationships of Depressiveness as a trait, with behavioral Activation, and Avoidance. Method: A cross-sectional research was conducted on a sample of 504 students of different levels and courses of education in the Serbian speaking area. Results: Serbian version of Mindful Attention and Awareness scale demonstrated high reliability (α=0.83) and a single factor solution that was found to be the most adequate. Significant correlations with theoretically related positive psychological constructs such as Gratitude (r=0.12, p<0.001), Self-compassion (r=0.46, p<0.001) and its components such Self-kindness (r=0.21, p<0.001), Over identification (r=-0.47, p<0.001) and Mindfulness (r=0.29, p<0.001) were found. It was also the case for distress components such as Depressiveness (r=-0.41, p<0.001), Anxiety (r=-0.46, p<0.001) and Stress (r=-0.50, p<0.001), as well as for Behavioral activation for depression (r=0.46, p<0.01) and its components Activation (r=0.34, p<0.01) and Avoidance (r=-0.35, p<0.01). Additionally, it was found that Mindful Attention and Awareness significantly mediates the relationship between Depressiveness and Activation as well as in the case of Depressiveness and Avoidance. Conclusion: Along with the study limitations, the mindfulness enhancing effect was discussed in accordance with its potentially mitigating effects on unpleasant automatic states and regulation of behavior patterns, so that it might contribute to the development of value-guided behaviors. Key words: Mindful Attention and Awareness; Depressiveness; Behavioral activation; Avoidance
INSTITUTE FOR FORENSIC PSYCHIATRY SOKOLAC
Although it began its official work less than a decade ago, the idea of establishing the Institute for Forensic Psychiatry arose in the seventies of the last century, when a department for forensic psychiatry was formed in the Sokolac Psychiatric Hospital, where patients are placed for the execution of security measures of mandatory custody and psychiatric treatment. . The building where the Institute is located today was built in the early 90s of the last century, but due to the outbreak of the civil war in Bosnia and Herzegovina, it was not put into operation. The institute was officially opened in 2014, and the funds for the reconstruction and equipping of the facility were provided by the Government of Switzerland and through the Ministry of Justice of Bosnia and Herzegovina. The Institute of Forensic Psychiatry in Sokolac is the only institution of this type in Bosnia and Herzegovina, and as such it is a reference institution for scientific research in the field of forensic psychiatry, and a center for the education of medical students, undergraduate and postgraduate studies, and psychiatry residents.