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The lack of clarity as to the scope of the health insurance exception enshrined in Article 206 of the Solvency II Directive has created uncertainties surrounding the implications for government intervention in the private health insurance market. A contentious interpretation of the health insurance exception, offered by former EU Commissioner Bolkestein, and the approach subsequently taken by the Commission and the Court of Justice of the European Union in assessing the compatibility of Member State intervention in private health insurance have led to a divergence in the application of EU law, which further increases uncertainties around the legality of Member State intervention. This article proposes an alternative interpretation of the health insurance exception that draws on a contemporary understanding of private health insurance as a socio-economic institution aimed at achieving a highly competitive social market economy. This alternative interpretation extends the applicability of the health insurance exception from substitutive private health insurance to complementary private health insurance that covers statutory user charges and thus improves the compliance of national health insurance systems in several Member States with EU law and enhances the coherence of EU law.
Numerous researches show significant presence of cardiovascular disorders, especially hypertension in depressed patients that show up several years after first depressive episode.
Mortality caused by cardiovascular disorders in depressed patients is 50% higher than in general population. Comorbid depression and cardiovascular disorders is making worse health condition, increasing suffering, making hard treatment, and outcome is not good.
The goal is to confirm presence of hypertension in depressed patients as the most common comorbid cardiovascular diseases.
A retrospective study has been conducted using data from medical history of 274 depressed patients hospitalized and treated at the Psychiatric Clinic, Clinical Center Banjaluka. These parameters were assessed: sex, age, number of hospitalizations, marital and employer status, comorbid disease, BMI, presence of hypertension, lipid status and glicemia's level. Data were presented using tables and graphs.
Results obtained in our study were:
Hypertension in comorbidity with depression was found in 106 patients (38,5%), 75 of them were males and 31 of them were females. The majority were at age 40-60 years. Obesity was found in 21% of them. High lipid's level was found in 20% of them. 11% of patients had high level of glicemia. More than half of the patients had lower socio-economic status.
Depression is often accompanied by cardiovascular disorders. It is very important to recognize this comorbidity in order to treat it successfully and to make better treatment's outcome.
New dimensions of traumatic stress have surfaced since the inclusion of the PTSD classification in The Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III) with its main focus on Vietnam Veterans. New Dimensions of traumatic stress entered the clinical/cultural equation with new populations, both military and civilian, subjected to massive disasters (hurricanes, floods, terrorist's attacks…) as well as those exposed to the potential of violence. The nearly four-year siege of Sarajevo and the constant fear of improvised explosive devices and suicide bombers among troops in Iraq and Afghanistan add another dimenstion of traumatic stress that falls outside the usually accepted “combat exposure” measure for a PTSD diagnosis. Our objective was to evaluate the scientific and clinical literature to see what assessment and treatment modalities are being employed to address this broader definition of traumatic stress.
We conducted a comprehensive review of journal articles and books published in English and the Slavic languages, the vast majority published within the past decade.
The search comprised of over 300 hits, mostly journal articles.
Assessment tools have been expanded to include co-morbid clinical and health diagnoses as well as pre-morbid factors. Related clinical diagnoses include major depression and panic attacks while health concerns run the range of immune deficiency disorders as those associated with traumatic brain injuries. Psychopharmacology inroads seem to focus on Serotonin agonists while cognitive-behavioral approaches dominate the psychotherapies. Targeted populations include coalition troops (male & female) and those involved in the Bosnian and Kosovo conflicts.
Absence of social support has its role in the etiology and maintaining of depression, showing inability of the depressive subjects to built and to sustain interpersonal relationships, and to mobilize social support at the time of crisis. The objective of our investigation was to establish the level of social support in the patients suffering from dysthymic disorder, in the course of the disorder.
The sample participants included 40 patients who fulfilled DSM-IV criteria for the dysthymic disorder (mean age 40.65, SD 3.70), and 40 corresponding healthy controls (M 37.50, SD 8.05). The following instruments for assessment of social support were used: Social Support Index, Family Hardiness Index, Family Coping Coherence Index, Relative and Friend Support (McCubbin, et al., 1982,1986).
The dysthymic disorder patients compared to the healthy controls, had statistically significant lower values (p< 0.001) of Social Support Index, Family Hardiness Index, Family Coping Coherence Index and of Relative and Friend Support.
In the course of the disorder, those suffering from dysthymic disorder compared to the healthy controls, had a significantly lower level of social support, indicating absence of a reparative role of social support in maintaining the psychological well-being.
Who or what is responsible for sex caused differences in brain structure and functioning: our biological inheritance or is it simply the consequence and the result of learning, experience and socio cultural influence? Scientists with different approaches and different orientation agreed in one: responsibility for sex caused differences of cognitive capabilities share innate (genes and hormones) and acquired (experience and learning) factors.
Studies which consider cognitive abilities males and females are mostly done with heterosexual and homosexual individuals. The aim of this study was to asses some aspects of cognitive functioning of female-male transsexuals (FMT) and to compare it with the model of functioning of heterosexual female (HF) and male (HM) individuals.
Experimental group consisted of seven FMT and 14 individuals were in HS group (seven in each, HM and HF). FMT were in stage of preparation for operative treatment, and transsexualism was diagnosed and guided within this program. We used Thurstone Test of Verbal Fluency as a written test for word fluency.
Results and conclusion
The results showed that in the first part of the test (words starting with S) F-M transsexual group was the worst, and in the second part of the test (words with 4 letters starting with K) they had the score closer to homosexual females. Higher score in the last minutes in both parts of test had the group of F-M transsexuals and male heterosexuals. This could be interpreted as an outcome of better attention of individuals in these groups.
Studies have shown police corruption to be a major problem within the police and security forces in the former war-torn Balkan nations, notably Bosnia-Herzegovina, Croatia and Serbia. Current European Union and USA training programs do not adequately address the issue of mental and character suitability for law enforcement personnel. An existing, and little used, Slavic-language version of the Minnesota Multiphasic Personality Inventory (MMPI-201) is grossly lacking in that it is too short a version and does not lend itself to the rich predictived material that makes the MMPI a viable and strong assessment tool. The MMPI-201 profile also omits critical clinical scales.
We have translated and modernized the first 360 items in the original MMPI into the Slavic language thereby providing a viable personality inventory that can draw on over 60 years of predictive research relevant to professional suitability as well as ruling-out any presenting clinical mental health and/or charaterologic problems. We are currently in the process of validating this instrument by using both the “alternate test” and “test-retest” modes. Here, students, who are competent in both the Slavic and English languages, enrolled in the College of Criminal Sciences and the Law, in both Bosnia and Serbia are administered both the English and Slavic-language instruments at different settings at least a week apart. Both versions are then compared for each subject (N= 50 to 100 for each country) relevant to an estimation of fit for assessing the reliability of the Slavic-Language Personality Inventory.
The last few years have been a period of great changes and significant social turmoil in Serbia. People have lived, and still so, under a state of prolonged stress. There are very few investigations about suicide in last 15 years.
The aim of this study was to investigate profile of males who have committed suicide in Belgrade during eight year period.
Data were taken from the index records of suicide in the city of Belgrade, held at the Institute for Informatics and Statistics. Nine availed variables were analyzed. Statistical analysis was done by using the crude specific rate.
The results of our study gave main characteristic of male who have committed suicide in analyzed period considering age of suicide, education and profession structure, area of living and area of suicide, month, time and method of suicide and annual suicide rate.
By this case report the authors will emphasize the importance of systematic psychiatric exploration in clinical practice with gender identity disorders. Standard procedures have diagnostic and differential diagnostic purpose (exclusion of other psychiatric disorders or comorbid psychiatric disorders).
Presented patient is 20 year old female who addressed to Belgrade Team for Gender Identity for routine psychiatric exploration with suspicion of female-to-male transsexualism. As a contribution to mentioned diagnostic category the authors have noted long term persistence of gender dysphoria through puberty and adolescence, persistent wish for partial sex reassignment surgery, specific defense mechanisms and intake of testosterone without medical prescription.
Applied diagnostic procedures and complementary analysis (EEG, NMR) have imposed doubts in primarily suspected transsexualism and leads us toward differential diagnosis analysis for organic or psychotic mental disorder.
Risk health behavior can influence coronary syndromes outcome, especially associated with undesirable psychological reactions. Anxiety and depressive syndromes could be associated with higher frequency of smoking, alcohol consumption and lack of physical activity.
Assesment of differences in psychological and behavior parameters between acute coronary and healthy controls and influence on 6 months re- hospitalization rate.
Comparation between K group = 33 of first myocardial infarction patients and E group = 30 healthy persons at baseline and after 6 months. Instruments applied:
Semistructured psychiatric interview, M.I.N.I., Beck Anxiety Inventory (BAI) for anxiety level, Beck Depression Inventory (BDI) for depression level, KON-6 sigma Aggression Scale and Holms-Rahe (H-R) Stress Life Events Scale and Questioner for risk health behavior. Parameters differences were assessed by t-test chi square test, for p< 0,05. Regression analysis for 6 months re-hospitalization.
Anxiety-depressive and Anxiety syndromes were present at 23% of K group and 10% of E group. Anxiety level of K group was higher than E: (BAI = 8,15 ± 4,37:4,83 ± 2,60; t = −3,62), for p < 0.01, depression level was also higher (BDI = 8,67 ± 3,94: 4.63 ± 2.04; t = −5,02). Lack of physical exercise, was more present at K group. After 6 months there were 11 rehospitalization in K group. Family history of coronary disease and alcohol consumption had significant influence on 6 months re-hospitaization of infarct patients.
Anxiety and depression levels are mild in K group. Risk health behavior has been present at bouth groups but alcohol consumption and family disposition are important for re-hospitalization
Carbamazepine was the first anticonvulsant widely used in psychiatry, first for the treatment of bipolar disorder and later for other psychotic disorder (adjunctive). Some of the side effects, which usually occur at the beginning of the therapy with this medicament, are hematological changes which consider transitory leucopenia (10%), persistent leucopenia (2%) and rarely thrombocytopenia. Just these side effects were registered in patient described in this paper.
26 year old men diagnosed as schizophrenia (according to ICD X criteria) was administrated carbamazepine as adjuvant therapy because difficulties in behavior control, seven years ago in dosage of 400mg daily. After four years of therapy, on routine complete blood count (CBC) checking decreased number of white blood cells (2.9 white cells/mm3) and platelets (110000/mm3) were registered. Carbamazepine was excluded from therapy immediately, and from that time on patient is under a regular control of hematologist who diagnosed Bicytopenia (Leucopenia and Thrombocytopenia) and prescribed multivitamin therapy. After three years of these changes, CBC normalized. This entire time patient did not have any symptom which could consider immunological trouble or problem with blood coagulation.