Southeastern European Medical Journal (SEEMEDJ) is the official publication of the Faculty of Medicine, Josip Juraj Strossmayer University Osijek, Croatia
Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
Attitudes and Activities of Primary and Secondary School Pupils and Medical Students in Relation to Social Networks, Sport, Friends and the Use of Mobile Phones
Aim of the study: The aim of the work is to find out what primary and secondary school pupils and medical students think and talk about most often, how they use mobile phones and social networks, and to identify possible interventions that could promote socialising with friends and sporting activities. Methods. The attitudes and behaviours of primary school pupils (N = 51), high school pupils (N = 69), and medical students (N = 108) were compared using a questionnaire on the frequency of activities during the long breaks between lectures. Answers were provided on a 1 to 5 Likert scale. Results. The topic most frequently discussed by all respondents was school (median 4 [IQR 3-5], P = 0.77), while primary school students most frequently discussed and thought about sport (3 [2-4]). High school pupils and medical students discuss and think about food (4[3-4]) and love (4[3-4]) as well. Primary school pupils rarely use social networks (1[1-2]), while high school pupils and medical students use them frequently (4[3-5]) and often search in the networks (4[3-5]) (P<0.001 between primary school pupils and older pupils and students). All respondents believe they should spend more time with friends in person (5[4-5] for all, P = 0.485, ns). Conclusion. Primary school children have the greatest interest in sport and it is at this age that systematic educational programmes should be implemented to encourage participation in sport. Older respondents are more likely to think about having fun. Leisure activities can be a more effective motivator to stimulate their interest in sport and build personal bonds.
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Transgenerational Transmission of Trauma
Transgenerational trauma is a term which describes transmission of trauma on next generation, it is defined as relation trauma. It's a proces sin which parents transmiss their own unresolved trauma on their children by specific interactions which results with their children experiencing the trauma without the real experience of trauma. Iti s also called intergenerational, multigenerational trauma. On the next generations transmiss silence or narrativ on traumatic experience. Transgenerational trauma can affect self, affect, cognitive and interperonal functioning. We will present story o fan 17 year old adolescents.
The Concept of Social Support Theory as a Resource in Psychiatric Care
Introduction - An adequate level of social support can significantly improve patients' health status, their health behaviors, and the utilization of health services. Although there are many theories addressing social support, it is essential to analyze and evaluate them before applying them to Croatian nursing practice. Miriam J. Stewart's social support theory can provide substantial assistance to nurses in planning interventions to improve health outcomes. The aim of our research was to analyze and evaluate this theory. Methods - The theory was analyzed and evaluated according to the criteria proposed by McKenna, Pajnkihar, and Murphy. Databases Medline and CINAHL were searched, as well as relevant articles and books available online, using English MeSH keywords: social support, nursing, theory, evaluation, and analysis. Results - A total of 32 articles and three books were analyzed. The social support theory belongs to the middle-range theories in nursing, which deal with structure and interactional relationships. Interactions and relationships with members of social networks can be supportive or unsupportive, thus affecting physical, psychological, and spiritual health and well-being. Social support is a key concept in nursing due to its impact on health and health behavior, and it is suitable for developing empathy and responsiveness to patients' needs. Stewart proposed five main interventions aimed at individuals, dyads, groups, communities, and the social system. Three reliable and valid instruments for measuring social support have been developed. Conclusion - The described theory has great potential for improving nursing practice, but it must first be included in Croatian nursing education so that nurses can acquire the necessary knowledge about nursing theories. The theoretical settings need to be tested in clinical practice.
Exposure of Physicians to Workplace Violence
Introduction: The main goal of the research was to determine whether the doctors who work at the Clinical Medical Center Osijek are exposed to violence in the workplace, in what form of violence, whether there are differences in exposure between doctors according to age, gender and depending on whether they are specialists or residents. Participants and methods: This study is organized as a cross-sectional study. 101 doctors employed at the Clinical Medical Center Osijek participated in this research. The data were collected by answering an anonymous online questionnaire. Results: The majority of respondents who were exposed to violence at the workplace indicated that they had experienced verbal abuse (41.6%), followed by mobbing (21.8%), physical (5%) and sexual abuse (3%). Conclusion: Due to the small sample of the study, there are no significant differences in the distribution of respondents according to exposure to any form of violence in relation to gender, age or whether they are residents or specialists.
“Third wave” Therapies of Behavioral-Cognitive Therapies in the Treatment of Trauma
Techniques from the field of behavioral-cognitive therapy (CBT) have proven to be effective in the treatment of people suffering from post-traumatic stress disorder (PTSD), while in recent times more and more attention has been focused on checking the effectiveness of the so-called third-wave of CBT. Research shows that practicing mindfulness techniques, or focused awareness, can help reduce symptoms of PTSD, such as heightened arousal, recurring night terrors and difficulties with emotional regulation. The effectiveness of these procedures is based on teaching individuals how to focus on the present moment instead of giving in to recurring traumatic thoughts or feelings. In addition, mindfulness can help develop better regulation of emotions and reactions to stressful situations. Also, Acceptance and Commitment Therapy (ACT) techniques have shown promising results in the treatment of trauma. ACT is a form of therapy that focuses on changing the individual's relationship to their thoughts and feelings, rather than changing the content of thoughts and feelings. In the context of PTSD, ACT can help individuals learn to accept traumatic experiences and the feelings that accompany them instead of fighting or repressing them. Acceptance allows people with PTSD to release the feelings of guilt, shame or helplessness that often accompany their reactions to trauma. Additionally, ACT helps individuals identify their values and goals and commit to acting on them, despite the PTSD symptoms they experience. The commitment described can help reduce the avoidance of anxiety-provoking situations or recollections of traumatic events, which can contribute to improving the quality of life of people with PTSD. In conclusion, research confirms the effectiveness of third-wave CBT techniques in the treatment of trauma, but the need for an individualized approach to each patient and the integration of the described techniques into a broader treatment plan that may include other therapeutic modalities depending on the needs of the individual is highlighted.
With the aging population, the prevalence of oncological and other incurable chronic diseases is increasing, which raises the demand for palliative care. Patients in the final stages of illness often experience reduced food and fluid intake, leading to dehydration, while impaired swallowing hinders the oral administration of medications. Traditionally, fluid replacement is performed via intravenous (IV) routes; however, in elderly patients with long-term comorbidities and compromised veins, establishing venous access can be challenging and traumatic. Subcutaneous infusion, also known as hypodermoclysis, represents a simpler and less invasive alternative, especially in palliative care. Hypodermoclysis enables safe and effective administration of fluids and medications into the subcutaneous tissue, reducing the need for repeated venipunctures and minimizing patient discomfort. This method has a long history, first being described in 1865 during a cholera epidemic. Despite its longstanding use, it is still not widely recognized among healthcare professionals. Its advantages include ease of application, lower costs, and the potential for use in home settings, allowing patients to remain in a familiar environment. This study involved a literature search in databases such as PubMed, Scopus, and Web of Science, focusing on research published after 1995. A total of 401 studies, including meta-analysis, review articles, and clinical trials, were analysed to assess the efficacy and applicability of subcutaneous infusion in palliative care. The results indicate that hypodermoclysis is a suitable method for fluid replacement and medication administration, with a lower risk of complications compared to intravenous therapy. Subcutaneous infusion is a safe, effective, and easily applicable method in palliative care. Its wider application can improve the quality of life for patients in the terminal stages of illness, reduce unnecessary medical procedures, and facilitate care in home settings with the active involvement of family members and palliative care teams.
Coronary Angiography Optimized by Optical Coherence Tomography in Patients with Coronary Artery Disease
The aims of the study: The aims of this study were to examine whether there is a difference in the clinical findings of the lesion obtained by coronary angiography and OCT and to examine the association of OCT findings in the decision-making on additional optimization of PCI. Respondents and methods: The research was conducted as a cross-sectional study using historical data. The study included patients who underwent OCT at the Department of Cardiovascular Diseases of the Osijek Clinical Hospital Center from 2021 to 2023. Results: The research involved 62 patients, with a median age of 67. The most common location of the lesion was the LAD, in 52 (84%) cases. Thirty-nine respondents (63%) required additional optimization. Three (5%) patients were recommended for cardiosurgical consultation based on OCT. There was a significant increase in the length of the LAD (Wilcoxon test, P < 0.001), LCx (Wilcoxon test, P < 0.001), and RCA (Wilcoxon test, P = 0.006) as measured by OCT compared to coronary angiography. Regarding proximal width, the values for the LAD (Wilcoxon test, P < 0.001) and RCA (Wilcoxon test, P = 0.03) were significantly higher. Conclusion: The research demonstrated the important role of OCT in clinical practice, particularly in the detailed assessment of coronary artery lesions, management of PCI, and assessment of additional optimization in patients with coronary disease.
Very Early Treatment of Recurrent Strokes with Mechanical Thrombectomy in a Patient with Severe Anemia
Introduction: Recurrent ischemic strokes requiring repeated mechanical thrombectomy (MT) within 24 hours of the initial event are uncommon. This case report describes a 61-year-old woman who underwent two MTs 6 hours apart for ischemic strokes associated with severe anemia due to pure red cell aplasia (PRCA) in different vascular territories. Case Presentation: The patient, with a history of PRCA presented with left-sided hemiparesis and facial paresis. Neuroimaging revealed a right middle cerebral artery (MCA) M1 segment occlusion. She underwent MT with complete recanalization. Four hours later, new neurological symptoms emerged due to a left MCA occlusion, and a second MT was performed successfully. Management and Outcome: Alongside MTs, the patient received supportive care, including blood transfusions, analgesics, and anticoagulants. Her neurological status improved significantly two weeks upon discharge with residual left-sided weakness and facial paresis. At 90 days, the patient was able to walk, indicating further functional improvement. Discussion: This case is notable for the short interval between two MTs and the patient's underlying hematological condition. Severe anemia and PRCA likely contributed to hypercoagulability and increased stroke risk. Despite these unusual risk factors, the patient’s outcome was favorable, which is consistent with the effectiveness of repeated MT for early recurrent ischemic strokes. Conclusion: Early recurrent stroke in different vascular territories, particularly in the context of hematological disorders, is rare but can be managed effectively with timely MT. Further research is needed to evaluate stroke recurrence risk and therapeutic responses in patients with hematological conditions, including PRCA and severe anemia.
Influence of Phacoemulsification on Intraocular Pressure in the Eye after Trabeculectomy
Aim: The aim of this study was to question whether there is a difference in the change of intraocular pressure (IOP) between groups of participants, achieved by phacoemulsification after trabeculectomy, considering the height of IOP at beginning. As well as whether there is a decreased necessity for topical antiglaucoma (ATG) medications. Participants and methods: Study was conducted on 26 participants submitted to cataract surgery after trabeculectomy at the Clinic for Eye Diseases in Osijek (January 2017 - December 2019). IOP values were noted at day zero, seventh day, after a month and six months after patients underwent cataract surgery with phacoemulsification; also, number and type of topical medications. Results: Historic cohort study included 26 patients (19 women, 7 men). Statistically significant decrease of IOP was noticed from day zero and six months after (Friedman's test, P < 0.001). Significant difference was in measured value of IOP at day zero and the first day (Friedman's test, P < 0.05). No statistically significant difference was in participant groups according to IOP (Marginal Homogeneity test, P = 0.06). Conclusion: Trabeculectomy alone and trabeculectomy combined with phacoemulsification, are justified procedures to achieve a decrease in the IOP value and its regulation with subsequent possibility of decrease in usage of local ATG therapy. Phacoemulsification after trabeculectomy ensures an additional decrease of the IOP.
Comparison of Modern Surgical Techniques in a Treatment of Myopia
Aim: To examine whether there is a difference in the outcomes of surgical techniques photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK) and implantable collamer lens (ICL) for: short-term visual outcome after 6 months, long-term visual outcome after 24 months, procedures safety and remaining refractive error after surgery. Methods: The research was conducted on patients with myopia and myopic astigmatism. Data was collected on the surgical technique performed binocularly: PRK, LASIK or ICL. Visual acuity was measured: before the procedure, 6 months after the procedure and 24 months after the procedure. Data were collected on the occurrence of complications and performed additional corrections. Results: The research was conducted on 150 patients. The median age was 33 years with an interquartile range of 28 to 39 years. The visual outcome was satisfactory in all three groups during two measurement periods after 6 months and after 24 months after procedures. Complications in this study occurred in 13 patients (8,7 %), mostly in LASIK group with total of 11 patients. Suboptimal refractive result that was corrected by additional correction amounts 1,3 % meaning only 2 of patients underwent the correction procedure due to suboptimal refractive error. Conclusion: Short-term and long-term visual outcome after binocularly performed PRK, LASIK and ICL showed success in all groups. ICL and PRK showed the highest safety rate, while LASIK had more frequent complications in this study. A suboptimal refractive result occurred rarely and were additionally corrected if needed.
The Role of Transgenerational Transmission in the Psychological Adjustment of Women with Breast Cancer
Suffering from cancer is a traumatic event for the affected person and can result in a whole series of psychological difficulties, and invasive methods of treatment further deepen them. The previously experienced psychological trauma of a close person can influence the response of a person who is currently experiencing trauma because the far-reaching power of post-traumatic consequences extends through a natural biological barrier far into the next generation (the so-called “transgenerational impact of traumatization”). Sufferers often transfer their fears to their children, changing their responses, with the development of anxiety and depression, especially in traumatic situations (such as when dealing with cancer). Post-traumatic stress disorder (PTSD) in patients who have had a family member with cancer can be reactivated PTSD, developed in the past by living with a close person who was treated for cancer, but it can also manifest itself as a new disorder. By including cancer patients in psychotherapy procedures, we can prevent the development of more severe psychological responses in the second generation, which due to the genetic influence in the inheritance of the disease, will develop cancer and the psychological disorder associated with it, and have a far-reaching effect on strengthening adaptation mechanisms.
Over the past few decades, we have witnessed the unsuspected development of personalized medicine, which uses modern knowledge of neuroscience, nanotechnology, modern methods of imaging the human brain, genetics, etc. However, it has also become clear that in the increasing fragmentation of medicine, the holistic approach is increasingly being lost and that the foreground diseased organ or diagnosis is from the person with all his dimensions of health and illness. It is precisely for this reason that the movement of psychiatry and the entire medicine directed towards the person is developing in the world. Person-centered psychiatry is an initiative that places the patient's whole person at the center of mental health care. Its goals are highlighted by the promotion of psychiatry for the person (the overall health of the person, including illness and positive aspects), for the person (help in fulfilling the life goals of each individual), by the person (with clinicians who act as whole beings, scientifically rooted, with high ethical aspirations) and with a person (in cooperation with a person who is a representative of health care based on respect and empowerment). The person is placed in context, in accordance with the words of Ortega y Gasset: “I am me and my circumstances.” An approach that connects science as an essential tool, clinical practice and medical ethics is becoming a growingly recognized need in all medicine and care. The goal is to overcome reductionism and accept complexity in clinical practice, as well as to demonstrate empathy, understanding, prudence and intuition that are integrated with scientifically and clinically based therapeutic strategies. The definition of health which originated from prof. dr. sc. Andrija Štampar is gaining more and more importance today, and the concept of total health and total care is slowly being introduced. In her presentation, the author will present these contemporary concepts, with a special emphasis on psychotrauma.
Psychotic Disorders and Posttraumatic Growth
Posttraumatic growth (PTG) represents the phenomenon of positive changes that a person can experience after a traumatic experience. Traditionally associated with traumatic events such as loss or injury, PTG is increasingly being investigated in people with psychotic disorders. Although psychotic disorders are often associated with severe symptoms and often gradual dysfunction of individuals, some research suggests that some patients may experience positive changes after psychotic episodes. These aspects of growth may include a deeper understanding of one's own emotions, strengthening of personal resolve and increased empathy for others. However, it is important to point out that PTG is not a universal result of a psychotic experience and that some individuals may not experience these positive changes. Understanding PTG in people with psychotic disorders can provide useful insights into their psychological functioning and serve as a basis for developing guidelines for therapeutic interventions aimed at stimulating personal growth and development in this population. Although this field is still relatively new and requires further research, consideration of PTG may expand our understanding of the experience of people with psychotic disorders and offer new opportunities for therapeutic interventions and support.
Psychotrauma and Psychosomatic Disorders in Women
Women's mental health plays a key role in their overall well-being and quality of life. During the life journey, women face various stressors and life factors that can significantly affect their psychological state. From adolescence to menopause, as well as life stages such as pregnancy, women are particularly sensitive to changes in mental health. These changes can be the result of hormonal fluctuations, emotional challenges or social pressures. It is especially important to emphasize the possible psychological changes and challenges that pregnancy itself brings, as well as its possible outcomes, such as pregnancy loss, complications during childbirth or the birth of a child with malformations, because they can have a deep and long-lasting impact on a woman's psychological state. Also, psychological problems can be present even before conception, and pregnancy itself can further worsen them. Therefore, it is important to ensure careful monitoring of high-risk pregnant women by a multidisciplinary team of health professionals. High-risk pregnant women include those with pregnancy or childbirth complications, a history of mental disorders or sexually transmitted diseases, younger or older pregnant women, and pregnant women of low socioeconomic status. The aforementioned stressors, inadequate coping with challenges or exposure to chronic stress, can result in the development of various psychological symptoms and disorders in women, during and in the postpartum period, such as feelings of guilt, anxiety, “baby blues”, depression, panic disorders and even post-traumatic stress disorder. It is important to emphasize that long-term psychological stress and the development of psychological disorders can have long-term physical consequences for the woman and the child, such as the development of preeclampsia, problems with the child's birth weight and premature birth. These problems can interfere with the mother's daily functioning, damage the quality of relationships within the family, and have serious consequences for mental health. It is important that mothers receive comprehensive psychophysical support and understanding so that they can adequately cope with all the challenges that pregnancy can bring.
Application of Art Therapy with People Who Have Experienced Psychotrauma
This paper will present three art therapy activities used in working with people who have experienced trauma. During trauma, the prefrontal cortex is not functional, so trauma experiences are mostly stored as sensory information that is often difficult to translate into verbal form, which is why talking to a traumatized person is a real problem. A non-invasive approach is provided precisely by art therapy, as it enables gradual access to the traumatic experience – verbalization follows expression in art materials. Given that the trauma is stored in the body and in the form of scenes, the alternation of non-verbal and verbal parts of the art therapy session allows the client to gradually present the experienced scenes and stories. Externalizing traumatic content has a beneficial effect, it gives the possibility of separation and distancing from the experience, and once the experience is presented, it becomes material that can be reinterpreted from another point of view. Labyrinth, diorama and identification of parts of self activities were highlighted in the presentation, to present the possibility of working through trauma as part of the art therapy process on the examples of two clients of different ages and with different traumatic experiences. The activities were created according to individual therapeutic goals and for the needs of the respective clients, and their implementation resulted in a therapeutic shift. Three isolated examples will provide insight into the layering of art therapy as a form of psychotherapy that combines creative artistic expression with verbal expression. Through this kind of elaboration of artistic expression, cognitive insights and awareness are reached, which makes this approach extremely suitable for working with people who have experienced trauma.
Trauma and Psychosis: An Ecological Approach
When we talk about psychotic disorders, we should keep in mind that it is a very heterogeneous group of psychiatric disorders. It would be more accurate to talk about psychoses as a syndrome, that is, a feature of the clinical picture that can be caused by very diverse causes and is present in very diverse psychiatric disorders. In other words, psychosis is a feature of the clinical picture in which delusional thoughts and hallucinations prevail, in various psychiatric disorders. Psychotic clinical pictures can be present from dementia, acute psycho-organic syndromes, various addictions, mood disorders to schizophrenia, which are most often identified with psychoses, which is vicium artis. Environmental factors or ecological factors, as indicated in the title, according to our school of psychiatry, are very important factors in the emergence of psychotic clinical pictures in addition to biological and psychological ones. It should be noted that an acute or chronic psychoorganic syndrome without environmental stimulation in the form of light, day, clock or calendar will certainly have a more pronounced psychotic clinical picture. Addictions to alcohol and other addictions are an excellent example of how environmental factors can influence the clinical picture and the appearance of psychotic clinical pictures superimposed on the addiction. The means of addiction itself is an external factor that changes the quality of psychopathology, and if we add to that the ecological systems in which the individual lives and acts, for example, the work or family environment or other groups in which the individual affected by addiction acts, then the connection between ecological systems and psychopathology, trauma and psychosis becomes clearer. Mood disorders with psychotic clinical pictures become particularly complicated due to environmental factors and psychotraumatic events. Schizophrenics are particularly sensitive to environmental and traumatic events. Environmental factors play a special role in the formation of psychopathology, especially psychotic quality. Environmental factors such as deprivation, isolation, placement in an institution, lack of social contacts, etc. are true pathoplastic factors in the formation of the psychopathology of schizophrenia.
Posttraumatic Growth in Prisoners of War
Introduction: Numerous studies have shown that imprisonment is often an extremely traumatic experience, which is characterized by the exposure of the detained person to long-term and repeated traumatization, that is, to a series of traumatic events and situations of different characters. Because of its peculiarities, captivity is considered one of the most difficult human experiences. It is well known that being in captivity leads to significant negative consequences for mental health, the most significant of which is the development of post-traumatic stress disorder, as well as other mental disorders. Impaired mental health also leads to dysfunction in various areas of life and a significant decline in the quality of life. In addition to the pathological consequences of exposure to traumatic events, research has confirmed that various forms of traumatization can lead to positive consequences. Objective: The objective of this work is to show that post-traumatic growth, that is, positive changes after a traumatic experience, is possible even after the most difficult traumatic experiences, such as the experience of wartime captivity. Materials and methods: An extensive literature search was conducted on PubMed and Google Scholar. Using keywords, related terms and different combinations of them, the most relevant works dealing with the positive consequences of psychotrauma, i.e. imprisonment, were selected. Results and conclusion: For persons who have experienced wartime captivity, the experience of trauma, which is specific in many ways and leads to serious negative psychological consequences, can also lead to positive consequences of trauma. Research indicates that positive consequences do not reduce the pathological outcomes of trauma, and the development of positive changes is influenced by various factors.
Psychotrauma and Psychodermatological Disorders
The relationship between mental health and skin health is recognized in everyday clinical practice and is the subject of research in the field of psychodermatology. Along with the mutually unfavorable influence of certain psychological disorders and skin diseases, the issue of distress as a predisposing and precipitating factor for the development and course of skin diseases is investigated. It is believed that adverse life events in childhood, especially traumatic experiences in childhood, increase the susceptibility to the development of autoimmune and inflammatory diseases, as well as certain chronic skin diseases, and the same is known for chronic psychosocial stress in adulthood. Certain studies point to the connection of psychotrauma in childhood with psoriasis, alopecia areata, atopic dermatitis and hidradenitis, and the frequent comorbidity of post-traumatic stress disorder and psoriasis is also known, as well as cases. The authors of the relevant research conclude that the increased prevalence of emotional trauma in childhood in patients with hidradenitis suppurativa, alopecia areata and atopic dermatitis and psoriasis led to dysregulation of the immune system, i.e. anti-inflammatory response and dysregulation of the autonomic nervous system, and it is believed that early preventive psychotherapeutic interventions would in childhood contribute to the prevention of these biological changes in the organism, and the approach to a patient with skin disease should certainly include the identification and processing of psychotrauma and the treatment of comorbid psychological disorders. Therefore, in a psychodermatology context, it is recommended to include psychiatrists and psychologists in working with patients with skin diseases, in addition to dermatologists.
The Spiritual and Psychological Strength of Living According to the Beatitudes of the Gospel
The Beatitudes are the compass of Christian action, the worldview of a person who believes, and they are realized in concrete everyday life in dealing with painful situations in life since Jesus calls blessed the poor in spirit, the mourners, the meek, the hungry and thirsty for righteousness, the merciful, the pure of heart, then the peacemakers and persecuted for righteousness sake. These conditions and processes are often found in the background of people who have mild or severe mental difficulties. Jesus calls people blessed because they disapprove of violence, injustice, hypocrisy, heartlessness, wars, and at the same time, as a result of a traumatic experience, they leave behind, and in themselves, the light of a better world, already present and achievable, and not just “in another world”. In addition to being literary and stylistically extremely precious (e.g. woven into 72 words, i.e. 36 + 36), the Beatitudes contain a vertical (God-man) and a horizontal dimension (man-man) and are also a programmatic text, i.e. they bring about change at the reader. The text of the Beatitudes, without the man who reads it, would have no meaning, but likewise the man-believer without knowing and living the Beatitudes, remains a deeply impoverished being. In the midst of traumatic experiences, words of bliss become an instrument of growth to transform a person into a being with a strengthened identity. Bliss, symbolically speaking, is a violin that a person picks up as a result of life's sufferings, and by playing the composition changes the traumatic experience into an experience of growth.
Posttraumatic Growth of Parents of Children with Neurodevelopmental Disorders
Parents of children with complex medical conditions, including neurodevelopmental disorders, are daily exposed to numerous challenges that can have a negative impact on the psychological and mental health of caregivers. Research shows that the aforementioned parental population has a fourfold higher risk of developing post-traumatic stress disorder compared to the general population. Experiencing multiple, repetitive and overwhelming traumatic experiences can lead to the development of complex PTSD (ICD-11 categorization). However, in addition to negative, traumatic experiences can also result in positive consequences, the so-called post-traumatic growth. Then there is a reinterpretation of the trauma in a new form that leads to the enrichment of life and improvement in the domains: relationships with others, personal strengths, new possibilities, spiritual changes and life values.
Specificities and Challenges in the Treatment of Acute Stress Reaction in Children and Adolescents
Challenges in the therapeutic approach to the patient are inevitable, however, when our patient is a minor, it is clear that the challenges multiply. For almost every mental disorder, we take into account possible stressors that contributed to the disorder, however, in acute stress reaction disorders, as the name itself tells us, stress is directly related to the disorder. Individual vulnerability is directly related to the type of stressor that led to the disorder. This is a temporary mental disorder, and its outcome can be two-way, either a gradual withdrawal of the symptoms of the disorder or their chronicity, and therefore a change in the diagnosis as well as the approach to treatment. Exposure of children to stressful events is particularly vulnerable to their psychological functioning due to lack of life experience. The diagnosis is made through a detailed interview with the child and the parent, where the establishment of mutual trust depends on the approach to the child, and thus the success of further treatment. An indispensable detail is to pay attention to the parents' reaction as well as the consequences that the stressful event caused for them, that is, what are the consequences of facing a direct threat to their own child. Considering the possibility of retraumatization by repeated diagnostic procedures, it would be good to be equipped with both procedural instructions and equipment that will enable the quality of available medical services. Mutual cooperation of all involved professional services involved in the diagnostic and therapeutic part of the procedure is extremely important in order to minimize post-traumatic risk factors. The treatment approach must be adapted on a case-by-case basis so that the therapeutic outcome is as uniform as possible. In conclusion, success is essential if there is an adequate therapeutic approach to the child and parents/caregivers, and this is achieved through clear instructions, mutual cooperation and trust.
Complex PTSD - A Contextual Approach to the Treatment of Complex Posttraumatic Stress Disorder: A Proposal for New Therapeutic Guidelines
While experts and scientists agree on the first-line interventions for the treatment of post-traumatic stress disorder (PTSD), there is still an ongoing debate about the adequate treatment approach for complex post-traumatic stress disorder (C-PTSD). Meanwhile, different approaches to the treatment of C-PTSD are used in daily clinical practice. This paper aims to present a range of treatment options for C-PTSD in adults who have survived repeated exposure to severe violence and abuse, both in childhood and later in life. The developmental-contextual perspective of mental health forms the basis of this approach. The presented strategies are a combination of existing “evidence-based” approaches to the treatment of PTSD and personality disorders. In doing so, they take into account the personal development psychology of the patient, the current environment and the sources of the patient's resilience. The presented treatment model is based on many years of clinical practice and may be a promising approach to the treatment of C-PTSD. However, it is still necessary to scientifically examine its acceptability and effectiveness.
Rational Emotive Behavior Therapy and PTSD
The main aim of this review paper is twofold, to present findings as empirical evidence that supports the efficacy of Rationale Emotive Behavior Therapy (REBT) in the treatment of Posttraumatic Stress Disorder (PTSD) and to propose some novel ideas based on the idea of integration. REBT theory appears very well suited to studying posttraumatic stress responses as the theory suggests that such responses should not arise simply as a result of experiencing a traumatic life event, but rather that posttraumatic stress disorder will arise as a consequence of evaluating traumatic life events in a dysfunctional manner. Demandingness beliefs, awfulizing beliefs, low frustration tolerance beliefs and depreciation beliefs are therefore theorized to be critical cognitive vulnerability factors in the development and maintenance of severe and debilitating posttraumatic stress responses. Alternatively, the theory predicts that responding to such traumatic life events in a rational manner, exemplified by preference beliefs, non-awfulizing beliefs, high frustration tolerance beliefs, and acceptance beliefs, will mitigate against the onset of severe posttraumatic stress responses. REBT posits that humans are fundamentally inclined toward growth, actualization and rationality; yet at the same time humans experience opposing irrational dysfunctional tendencies. Post-traumatic growth (PTG) in the frame of traumatic experiences from a REBT perspective will also be discussed.
Stress in Children Whose Parents Suffer from Mental Disorders
It is already a well-known fact how important early life experiences are in shaping an individual's personality, and one of the most important factors that influence a person's psychological development are parenting styles and the attachment that develops between parents and children. Parenting is a complex process that carries with it a great responsibility, and consists of taking care of the child's basic, physiological needs, as well as raising, guiding and encouraging the child's cognitive, emotional and social development. Parenting can be a particularly big challenge for people suffering from mental disorders, and some studies show that children of parents suffering from mental disorders have a higher risk of developing mental disorders compared to the general population. They are at increased risk of experiencing emotional, developmental and social problems. The mentioned difficulties can be caused by biological predispositions, but also by environmental factors. Mental illness of parents can result in less emotional availability of parents to children and insecure forms of attachment, insufficiently adequate way of establishing communication towards the child, weaker ability to recognize the child's needs and in extreme situations can result in increased hostility towards the child, complete neglect, rejection and potential abuse. Numerous social and economic factors associated with the psychiatric illness of the parents can also adversely affect the child's development, and some of the more prominent ones are social stigma towards psychiatric illnesses, which affects not only the sick person but also family members, lack of social support, poverty and difficult access to education and employment. However, for many parents suffering from psychiatric illnesses, children represent a strong motivation for treatment. Providing support to children and parents, education and strengthening social support can significantly reduce the risk of developing psychological disorders in children themselves. We will present the findings so far in more detail on the case of a girl who grows up with a mother suffering from a mental illness. A 13-year-old girl comes to a psychologist because of the risky behaviors she has been prone to recently. After the psychological treatment, she was included in the counseling treatment of a psychologist, and the mother was referred to a psychiatrist by the psychologist. Only by synchronized work and cooperation in the treatment of the parents (in this case the mother) can we strengthen the mental health of the girl.
An Overview of Adjustment to a Traumatic Event within the Framework of Cognitive-Behavioral Therapy
Posttraumatic growth is a concept that describes the positive changes and personal development that can occur as a result of a traumatic experience. This involves profound changes in values, priorities, relationships and general outlook on life. These changes may include strengthening personal resilience, developing deeper compassion and empathy for others and a greater appreciation of life (Tedeschi & Calhoun, 2004). Cognitive-behavioral treatment (CBT) is a type of psychotherapy that is often used in the treatment of people with traumatic experiences. It is based on the idea that thought patterns and behaviors play a key role in emotional states. CBT focuses on identifying and challenging negative and irrational thoughts and on developing practical skills for dealing with challenging situations and emotions (Shubina, 2015). Post-traumatic growth suggests that people can go through a traumatic experience but at the same time develop new coping resources and strategies. CBT can help not only overcome the negative consequences of trauma but also lead to positive life changes (Knaevel et al., 2010). Objectives: The objective is to present the cognitive-behavioral treatment of a patient with emotional difficulties after highly stressful and traumatic life events. Materials and methods: The treatment included an initial assessment, psychoeducation about cognitive-behavioral therapy, stress, trauma and possible emotional and behavioral consequences, and a series of cognitive and behavioral interventions within the treatment. Results: The patient was involved in cognitive-behavioral treatment for 4 months through 16 individual meetings. All initially set general and specific goals were achieved. Conclusion: Cognitive-behavioral treatment proved to be an effective approach in dealing with the negative consequences of highly stressful and traumatic life events. Through a combination of cognitive restructuring and behavior change techniques, CBT helps identify and change dysfunctional thoughts and behaviors associated with trauma. The treatment also provides tools to deal with emotional reactions and helps achieve personal growth after the trauma.
A Stress Relief Program Focused on Recovery
In the summer of 2020, the Department of Psychotherapy at the Center for Outpatient Treatment, Rehabilitation and Education of the Vrapče Psychiatry Clinic launched an online “Antistress Program” in response to the needs of the population. The significant challenges and changes caused by the current epidemiological situation caused by the effects of the COVID-19 virus, the earthquakes that hit part of Croatia, and the general exposure to stressors both on a personal and overall social level have confronted us with the need for adaptation and the search for new ways of understanding stress in general. Through the years of implementation and evolution of the program, the Antistress Program has been modified with themes and implementation according to current changes that represent a stressor on the existing psychophysical balance of man, to which he reacts with his personal coping mechanisms with the stressor. The purpose of this psychoeducational program is to recognize and explore the mechanisms of dealing with stress, and to strengthen those mechanisms and strategies that are adequate in a stressful situation and effective in preserving health. Through the program, the goal is to raise awareness of one's own risk and protective factors in the context of multiple risks, integration of stressful experience, and emotional regulation in stressful situations, which contributes to strengthening one's own strengths, skills and coping mechanisms with stress. An interdisciplinary team consisting of a specialist psychiatrist, psychologist, social pedagogue, occupational therapists and nurses participates in the implementation of the program. An interdisciplinary approach and joint implementation of the program enables joint activities, creation and inclusion of thematic units, which helps in the recovery process of the patients included in the program. The paper presents an account of the psycho-educational Antistress Program through its contribution to the recovery of the persons involved in the program.
Two Case Presentations with Unexpected Outcomes after Childhood Trauma
Bowlby developed a theory of attachment that he describes as an enduring emotional bond between human beings, manifested by seeking closeness to a caregiver, especially in situations of discomfort. Children adjust their behavior to prevent separation from a primary attachment figure – someone who provides support, protection and care. Attachment theory provides a favorable foundation for understanding our two cases and their developmental pathways. It is about two women who experienced separation from their parents at an early age, and their grandmothers were important figures in their upbringing – with different outcomes. Many studies talk about the impact of traumatic events in childhood on the child's biological, psychological and social development. That is why the importance of early intervention which includes different treatment modalities is emphasized.
The Role of Resilience in Mitigating the Effects of Trauma on Mental Health
Psychological trauma manifests itself when an individual is faced with extremely stressful situations that exceed their ability to cope or integrate thoughts and emotions. Exposure to high-stress scenarios and trauma is correlated with an increased prevalence of mental health disorders, including depressive and anxiety disorders. Resilience, as a concept, is based on the belief that an individual has faced circumstances of “significant adversity” and responded positively, ultimately restoring or improving performance and psychological well-being. Definitions of resilience run the gamut from mere survival to adaptation, ability, healing, resilience, robustness and health. Cicchetti and Rogosch define resilience as: “a dynamic process involving the achievement of positive adaptation in the context of exposure to significant adversity that typically exerts major assaults on biological and psychological development.” Traumatic events can enhance or impede the development of resilience. When a disturbance occurs, there is a potential impact on the formation of a self-system adept at dealing with extraordinary circumstances. This can adversely affect fundamental aspects of resilience, such as strong, interpersonal relationships, optimal performance and adaptability in unpredictable situations. Traumatic events can disrupt, reconstruct or strengthen existing resilience or damage the intricate. The final outcome depends on the nuanced interplay of subjective experiential factors, functional domains and inherent characteristics of the traumatic events themselves. The research was conducted on the general population, aged 18 and over. The questionnaire consisted of demographic data of respondents, and an instrument for testing resilience: Connor-Davidson Resilience Scale (CD-RISC 25) and International Trauma Scale (ITQ). One hundred and four respondents participated in the research. Most of the respondents are female, married, with a high school diploma, and live in urban areas. The results of the research indicate that the majority of respondents believe in their own ability to adapt to changes and actively seek a humorous perspective as a mechanism for dealing with challenges. Also, most of the respondents did not experience traumatic events in the past month that would significantly affect their ability to cope with stressful situations. These findings provide insight into the psychological characteristics and stability of the majority of women who participated in the research.
Coping Styles of Nurses in Working with Psychiatric Patients
Coping refers to the conscious and voluntary thoughts and behaviors used to manage internal and external stressors. Coping mechanisms and defense mechanisms serve the common goal of alleviating or enduring stress. A number of coping mechanisms show utility in certain situations. Some studies show that a problem-focused approach may be the most beneficial coping style. Maladaptive coping includes strategies associated with negative mental health outcomes and increased psychopathological symptoms. Examples include detachment, avoidance and emotional suppression. The aim of this paper is to examine the main coping styles used by nurses in working with psychiatric patients. The research is structured as a cross-sectional study. Nurses/technicians of all levels of education who are currently employed and have experience working with psychiatric patients were included in the research. The criteria for inclusion in the research were the following: voluntary consent to the research and respondents older than 18 years. The excluded criteria were: respondents under 18 years of age and respondents who do not have work experience with psychiatric patients. A general demographic questionnaire that included six questions was used as a research instrument. A translated and adapted version of the Brief-COPE scale was used to examine coping styles. The results of this research reveal that nurses/technicians who care for psychiatric patients use positive coping styles more often than maladaptive ones. The conclusion of the research is that nurses/technicians who work with psychiatric patients use positive coping styles more often than maladaptive ones. This research highlights the importance of mindful coping strategies for managing stress in the workplace and the potential benefit of a problem-solving approach.