Soc. psihijat., 37 (2009) 165-174                                                                                                                         Izvorni znanstveni rad

RAZVOJNO-PSIHOLOŠKA, PSIHOSOCIJALNA I KRIMINOLOŠKA OBILJEŽJA POČINITELJA KAZNENIH DJELA S PREPORUČENOM PSIHIJATRIJSKOM MJEROM SIGURNOSTI

NADICA BUZINA, MIROSLAV GORETA, VLADO JUKIĆ, IVANA PEKO ČOVIĆ,
IVANA JOLIĆ i ROMEL KRAJAČIĆ

Psihijatrijska bolnica Vrapče, Zagreb, Hrvatska

          Cilj istraživanja bio je ispitati postoje li značajne razlike u razvojno-psihološkim, psihosocijalnim i kriminološkim obilježjima unutar kategorije smanjeno ubrojivih počinitelja kaznenih djela s preporučenom psihijatrijskom sigurnosnom mjerom i bez preporučene mjere. Uzorak je sačinjavalo 120 ispitanika koji su u razdoblju od dvije godine vještačeni u Centru za forenzičnu psihijatriju Psihijatrijske bolnice Vrapče i ocijenjeni smanjeno ubrojivim. Provedenim istraživanjem dobiveni su podaci da se sigurnosna mjera češće preporučivala osobama koje su odrastale u lošijim razvojno-psihološkim uvjetima, koje su bile liječene zbog ovisnosti, u kojih su već primjenjivane odgojne i sigurnosne mjere, koje su ranije kažnjavane i koje su procijenjene opasnijima.

Ključne riječi: smanjena ubrojivost, sigurnosne mjere, razvojno-psihološka, kriminološka obilježja

S U M M A R Y

DEVELOPMENTAL PSYCHOLOGY, PSYCHOSOCIAL AND CRIMINOLOGICAL FEATURES WITHIN THE CATEGORY OF PERPETRATORS OF CRIMINAL OFFENCES RECOMMENDED PSYCHIATRIC SAFETY MEASURES

N. BUZINA, M. GORETA, V. JUKIĆ, I. PEKO-ČOVIĆ, I. JOLIĆ and R. KRAJAČIĆ

Vrapče Psychiatric Hospital, Zagreb, Croatia

      The aim of the study was to examine whether there are significant differences in developmental psychology, psychosocial and criminological features within the category of perpetrators of criminal offences with diminished responsibility, both with and without psychiatric safety measures recommended. The study included a sample group consisting of 120 subjects undergoing forensic expertise and evaluated as having diminished responsibility at Department of Forensic Psychiatry, Vrapče Psychiatric Hospital during a two-year period. Study results revealed the safety measures to have been recommended more often to persons growing up in poor developmental psychological conditions, former addicts, persons that had already been subjected to educational and safety measures, former perpetrators sentenced for their offences, and persons evaluated as dangerous.

Key words: diminished responsibility, safety measures, developmental psychology, criminological features

Soc. psihijat., 37 (2009)   175-179                                                                                                       Izvorni znanstveni rad

POVEZANOST BRAČNOG STANJA I POSLOVNE SPOSOBNOSTI
U OSOBA OBOLJELIH OD SHIZOFRENIJE

MARIJANA PLEŠA MAŽAR i NINOSLAV MIMICA

Dom za psihički bolesne odrasle osobe »Zagreb», Sveti Križ Začretje i Psihijatrijska bolnica Vrapče, Zagreb, Hrvatska

                Cilj rada bio  je utvrditi koliki je i kakav utjecaj bračnog stanja na poslovnu sposobnost bolesnika oboljelih od shizofrenije. Pretpostavka je bila da bolesnici koji su u braku zadržavaju poslovnu sposobnost duže i da se skrbničke dužnosti češće prihvaća bračni drug ili netko drugi u primarnoj obitelji. U istraživanju je sudjelovalo 140 oboljelih od shizofrenije koji su u tom trenutku bili na smještaju u Domu za psihički bolesne odrasle osobe «Bidružica» (53% žena i 47% muškaraca). U braku ih je bilo svega 13,6%, 67,1% nije bilo u braku nikada, a 16,4% ispitanih bili su rastavljeni. Potpuno lišenih poslovne sposobnosti bilo je 70 i isto toliko onih koji nisu lišeni poslovne sposobnosti. Ispitanici koji su bili u braku u prosjeku su lišeni poslovne sposobnosti sa  46 godina života, a oni koji nisu u braku sa 39 godina života. Nije pronađena statistički značajna povezanost između bračnog stanja i poslovne sposobnosti, ali je utvrđeno da je znatno više neoženjenih/neudatih lišeno poslovne sposobnosti u potpunosti u odnosu na one ispitanike koji nisu bili  u braku. S obzirom na spol ženski su ispitanici češće  dijagnosticirani kao oboljeli od paranoidnog tipa shizofrenije, a muški od rezidualnog tipa shizofrenije. Prevladavalo je neposredno skrbništvo a vrlo rijetko dužnost skrbnika preuzimao je bračni drug (15%). Primjenom Ljestvice socijalno adaptivnih funkcija pokazale su se velike razlike između osoba lišenih poslovne sposobnosti i onih koji nisu lišeni i to s obzirom na brigu o sebi, orijentaciji u prostoru i vremenu. Općenito, bolesnici koji su lišeni poslovne sposobnosti imaju nižu razinu socijalnog funkcioniranja.

Ključne riječi: poslovna sposobnost, shizofrenija, bračno stanje

S U M M A R Y

CORRELATION OF MARITAL STATUS AND WORKING ABILITY IN INDIVIDUALS WITH SCHIZOPHRENIA

M. PLEŠA-MAŽAR and N. MIMICA

Zagreb Mirkovec Nursing Home for Adult Mental Patients, Sveti Križ Začretje and Vrapče Psychiatric Hospital,
Zagreb, Croatia

      The aim of the study was to determine the impact of marital status on the work ability in patients diagnosed with schizophrenia. The study hypothesis was that married patients were keeping their working ability for a longer period of time, with the guardianship duties being more frequently performed by the spouse or other family members. The study included 140 schizophrenia patients (53% female and 47% female) at the time hospitalized in Bidružica, an institution for mentally ill adults. Only 13.6% of study subjects were married, whereas 67% were single and 16.4% divorced. Total lack of working ability and full working ability was found in 70 patients each. Among married patients, the loss of working ability occurred at about 46 years of age, as compared with age 39 in the groups of single and divorced patients. Statistical analysis did not confirm any correlation between marital status and working ability, however, analysis of causal connection showed the total lack of working ability to occur in single and divorced patients. According to sex, female patients had a higher prevalence of paranoid type of schizophrenia, whereas residual type predominated in male patients. Straight guardianship was predominant; guardianship was very rarely performed by the spouse (15%). The use of scale of social adaptability functions demonstrated significant variation between the patients deprived of and those not deprived of working ability, in terms of self care and orientation in time and space. In general, patients with deprivation of work ability had a lower level of social operation.

Key words: working ability, schizophrenia, marital status

Soc. psihijat., 37 (2009)  180-188                                                                                                                        Izvorni znanstveni rad

Sportsko klađenje - neke psihosocijalne karakteristike različitih kategorija kockara

Lidija Zajc i Nataša Jokić-Begić

Odsjek za psihologiju, Filozofski fakultet, Sveučilište u Zagrebu, Zagreb, Hrvatska

                Autorice su ispitale neke karakteristike patološkog sportskog klađenja. Istražile su postoje li razlike između različitih kategorija kockara u impulzivnosti i traženju uzbuđenja, uporabi psihoaktivnih sredstava te nekih ponašajnih aspekata sportskog klađenja. U istraživanju je sudjelovalo 95 muških sudionika, redovitih posjetitelja sportskih kladionica. Koristeći DSM-IV kriterije za poremećaj patološkog kockanja sudionici su podijeljeni u tri skupine: društvene (do jedan zadovoljeni kriterij), rizične (dva do četiri zadovoljena kriterija) i moguće patološke kockare (pet i više zadovoljenih kriterija). Rezultati su pokazali da 10,5% sudionika pripada kategoriji patoloških kockara, a 42% kategoriji rizičnih kockara. Patološki i rizični kockari se češće klade, uplaćuju više novčane iznose za klađenje te sudjeluju u većem broju kockarskih igara. Patološki se kockari još razlikuju od društvenih u češćoj konzumaciji lakih droga. Razlika među skupinama nije se pokazala ni u konzumaciji cigareta niti alkohola. Patološki i rizični kockari postižu više rezultate od društvenih u impulzivnosti, ali nema razlike u odnosu na traženje uzbuđenja. Dobiveni su rezultati pokazali da među korisnicima sportskih kladionica ima značajan broj ljudi s poteškoćama iz kruga patološkog kockanja, što ima implikacije za daljnja istraživanja i osmišljavanje preventivnih i kurativnih aktivnosti.

Ključne riječi: patološko kockanje, sportsko klađenje, impulzivnost, traženje uzbuđenja, uporaba psihoaktivnih sredstava

S U M M A R Y

SPORTS BETTING – SOME PSYCHOSOCIAL CHARACTERISTICS OF DIFFERENT TYPES OF GAMBLERS

L. ZAJC and N. JOKIĆ-BEGIĆ

Department of Psychology, School of the Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia

The aim of the study was to investigate some characteristics of pathologic sports betting and possible differences among various categories of gamblers according to the level of impulsiveness and search for excitement, use of psychoactive substances, and some behavioral aspects of sports betting. The study included 95 male subjects regularly attending sports betting pools. Using the DSM-IV criteria for the pathologic gambling disorder, study subjects were divided into three groups as follows: social (meeting up to one of the criteria), risk (meeting two to four criteria), and potentially pathologic (meeting five or more criteria) gamblers. Study results showed 10.5% of the subjects to belong to the category of pathologic gamblers and 42% to the category of risk gamblers. Pathologic and risk gamblers make bets more frequently, pay higher amounts of money and take part in a greater number of gambling games. In addition, pathologic gamblers differed from social ones by the more common use of soft drugs. There was no between-group difference according to the use of alcohol and cigarette smoking. Pathologic and risk gamblers showed a higher level of impulsiveness than social ones, whereas no such difference was found according to the search for excitement. Study results revealed a high proportion of pathologic gamblers among those visiting sports betting pools regularly, which obviously calls for further studies and development of preventive and curative activities.

Key words: pathologic gambling, sports betting, impulsiveness, search for excitement, use of psychoactive substances

Soc. psihijat., 37 (2009)   189-194 Izvorni znanstveni rad

KVANTITATIVNE EEG KARAKTERISTIKE U DEPRESIJI I SHIZOFRENIJI

VESNA POPOVIĆ-KNAPIĆ i DRAŽEN BEGIĆ

Klinika za psihijatriju, Klinički bolnički centar Zagreb, Zagreb, Hrvatska

               Povezanost, sličnost i razlike između shizofrenije i depresije proučavaju se još od Kraepelina. Ta je veza i danas aktualna usporedbom shizofrenog i bipolarnog spektra poremećaja. Elektroencefalografske studije pokazale su značajna odstupanja u shizofreniji (od 5% do 80 % shizofrenih ima promijenjen EEG nalaz) i depresiji (20% do 40 % depresivnih bolesnika ima EEG promjene). Istraživanja koja koriste kvantitativni EEG (qEEG) su pokazala različite nalaze u usporedbi shizofrenih bolesnika i zdravih ispitanika. Slična odstupanja uočena su u usporedbi depresivnih bolesnika i zdravih kontrola. Međutim, malo je istraživanja koja uspoređuju shizofrene i depresivne bolesnike međusobno metodom qEEG-a. Cilj: Usporediti qEEG parametre u shizofrenih i depresivnih bolesnika, koji su bez farmakoterapije.
              Metoda: EEG je snimljen u 20 depresivnih i 20 shizofrenih bolesnika. Metodom Fast Fourier Transformation (FFT) analizirano je 10 s dugo razdoblje, bez artefakata. Rezultati su prikazani kao amplitudni intenzitet (µV²) za delta (0,5 – 4,0), theta (4,0 – 8,0), alfa (8,0 – 13,0) i beta (13,0 – 30,0) ritam. Promatrane su regije: Fp1, Fp2, F3, F4, F7, F8, T3, T4, P3, P4, O1 i O2. Shizofreni bolesnici u odnosu na depresivne pokazuju porast delta aktivnosti nad Fp2, F4, F8 i T4 regijama. Interhemisferična asimetrija utvrđena je u shizofrenih, ali ne i u depresivnih bolesnika. Zaključak: Shizofreni bolesnici u usporedbi s depresivnim bolesnicima pokazuju porast sporih valova iznad frontalnih regija. Taj nalaz može poslužiti i u diferencijalno-dijagnostičkom razlikovanju shizofrenije i depresije.

Ključne riječi: kvantitativni EEG, depresija, shizofrenija

S U M MA R Y

QUANTITATIVE ELECTROENCEPHALOGRAPHY CHARACTERISTICS IN DEPRESSION AND SCHIZOPHRENIA

V. POPOVIĆ-KNAPIĆ and D. BEGIĆ

University Department of Psychiatry, Zagreb University Hospital Center, Zagreb, Croatia

      The association, similarities and differences of schizophrenia and depression have been investigated since the time of Kraepelin. This association remains a topical issue to the present comparing the schizophrenic and bipolar spectrum of the disorders. Electroencephalography (EEG) studies showed significant deviations in schizophrenia (altered EEG findings in 5%-89% of schizophrenic patients) and in depression (altered EEG findings in 20%-40% of depressive patients). Studies using quantitative EEG (qEEG) have reported different findings in schizophrenic patients and normal subjects. Similar aberrations have also been described on comparison of depressive patients and normal control subjects. However, only few studies compared schizophrenic and depressive patients by the qEEG method. The aim of the present study was to compare qEEG parameters between schizophrenic and depressive patients without pharmacotherapy. Twenty depressive and schizophrenic patients each underwent qEEG; 10-s period was analyzed by use of the Fast Fourier Transformation (FFT), without artifacts. Results were presented as amplitude intensity (µV²) for delta (0.5-4.0), theta (4.0-8.0), alfa (8.0-13.0) and beta (13.0-30.0) rhythm. The following regions were observed: Fp1, Fp2, F3, F4, F7, F8, T3, T4, P3, P4, O1 and O2. In comparison with depressive patients, schizophrenic patients showed an increase in delta activity over Fp2, F4, F8 and T4 regions. An interhemispheric asymmetry was recorded in schizophrenic but not in depressive patients. In conclusion, schizophrenic patients showed a rise in slow waves over frontal regions when compared with depressive patients. This finding may prove useful on differential diagnosis to distinguish between schizophrenia and depression.

Key words: quantitative electroencephalography, depression, schizophrenia

Soc. psihijat., 37 (2009)   195-204                                                                                                                                              Pregled

Uporaba psihofarmaka u trudnoći

OLIVER KOIĆ, PAVO FILAKOVIĆ, LJILJANA RADANOVIĆ-GRGURIĆ, DAVOR LAUFER,

IVAN POŽGAIN i JOSIPA IVANUŠIĆ

Klinika za psihijatriju, Klinička bolnica Osijek, Osijek, Hrvatska

               Za kliničara koji liječi psihički poremećaj, trudnoća pacijentice je poseban problem. Tragedija izazvana talidomidom ispravila je duboko ukorijenjenu zabludu o placenti kao učinkovitoj zaštiti od štetnih tvari. S obzirom da ne postoje dobro kontrolirana, prospektivna istraživanja o utjecaju lijekova na fetus i kasniji razvoj djeteta, a što će iz poznatih razloga i dalje ostati takvim, kliničari će i dalje biti nesigurni u procjenama mogućih rizika. Na temelju toga su autori u ovome radu prikazali dosadašnja saznanja o primjeni benzodiazepina, antidepresiva,  antipsihotika i afektivnih stabilizatora tijekom trudnoće. Rizike i koristi primjene lijeka mora se  procijeniti u svakom pojedinom slučaju, a liječenje se mora ograničiti na one slučajeve u kojima je rizik neliječenog psihičkog poremećaja za majku i fetus veći od rizika primjene lijeka.

Ključne riječi: psihofarmaci, trudnoća, teratogenost

S U M M A R Y

THE USE OF PSYCHOPHARMACEUTICALS IN PREGNANCY

O. KOIĆ, P. FILAKOVIĆ, Lj. RADANOVIĆ-GRGURIĆ, D. LAUFER, I. POŽGAIN and J. IVANUŠIĆ

University Department of Psychiatry, Osijek University Hospital, Osijek, Croatia

      Pregnancy poses a special problem for the clinician when treating psychiatric disorders in women. Thalidomide disaster had effectively dispelled the widespread but mistaken medical belief on the placenta to provide protection against potential teratogens. Since valid and controlled prospective data on the impact of drugs on fetal and subsequent development are limited and are likely to remain so, clinicians will continue to act in a state of potential uncertainty. To help determine which drugs can be used with relative safety during pregnancy, the authors reviewed critically the literature on the use of benzodiazepines, antidepressants, antipsychotics and mood stabilizers during pregnancy. The relative risks and benefits of drug therapy for these women should be weighed in each patient and treatment limited to those situations in which the risk for the mother and the fetus from untreated psychiatric disorder is presumed to exceed the risk of drug treatment.

Key words: psychiatric medications, pregnancy, teratogenicity

Soc. psihijat., 37 (2009)   205-211                                                                                                                                            Pregled

UPORABA TREĆE GENERACIJE ANTIPSIHOTIKA U DJEČJOJ

I ADOLESCENTNOJ DOBI

Katarina Dodig-Ćurković, Mario Ćurković¹, Ivan Ramčić,
Josipa Dodig-Radić² i Mislav Radić²

Klinički odjel za dječju i adolescentnu psihijatriju, Klinička bolnica Osijek,¹Specijalistička ordinacija obiteljske
medicine, Dom zdravlja Osijek i ²Klinički odjel za internu medicinu, Klinički bolnički centar, Split, Hrvatska

                Uporaba atipičnih antipsihotika u djece i adolescenata predmet je brojnih istraživanja zadnjih desetak godina. U tu skupinu lijekova se ubrajaju: ziprasidon, kvetiapin, olanzapin, sertindol, aripriprazol i risperidon. Autori iznose pregled novijih saznanja o toj skupinii antipsihotika s obzirom na moguće terapijske intervencije kod određenih poremećaja u dječjoj i adolescentnoj dobi, kao npr: poremećaja prehrane, autizma, shizofrenije, prve psihotične reakcije, bipolarnih poremećaja, pervazivnih razvojnih poremećaja, kontrole agresivnosti i impulzivnosti, ljutnje i sl. S obzirom na osjetljivo životno razdoblje praćeno intenzivnim metaboličkim i hormonskim promjenama važno je uzeti u obzir i mogućnost neželjenih učinaka treće generacije antipsihotika: galaktoreja, hiperprolaktinemija, smetnje menstrualnog ciklusa, osteporoza (djevojčice i adolescentice),  ginekomastija, seksualne poteškoće, hipogonadizam, ginekomastija (dječaci i adolescenti). Oba spola imaju povećani rizik od debljine, povišenih vrijednosti lipida i glukoze natašte, uz pojavu tipa II šećerne bolesti i probavnih odnosno urogenitalnih poteškoća. Autori zaključuju da je postavljanjem dobre dijagnoze, pravilnim odabirom odgovarajućeg antipsihotika i uz oprezno nadziranje neželjenih reakcija moguće ostvariti dobar terapijski odgovor i optimalan klinički učinak.

Ključne riječi: antipsihotici, atipični, mlađa populacija, neželjene reakcije

S U M M A R Y

THE USE OF THIRD-GENERATION ANTIPSYCHOTICS IN CHILDREN – NEW FINDINGS

K. DODIG-ĆURKOVIĆ, M. ĆURKOVIĆ¹¸ I. RAMČIĆ, J. DODIG-RADIĆ² and M. RADIĆ²

University Department of Child and Adolescent Psychiatry, Osijek University Hospital, ¹Family Medicine Outpatient Department, Osijek Health Center and ²University Department of Medicine, Split University Hospital Center, Split, Croatia

      The use of atypical antipsychotics in children is the subject of numerous investigations in the last ten years. This group of antipsychotics includes ziprasidone, quetiapine, olanzapine, aripiprazole, sertindole and risperidone. The aim is to review recent findings on this group of antipsychotics and indicate the possible therapeutic interventions in certain disorders in children and adolescents such as eating disorders, autism, schizophrenia, first psychotic reactions, bipolar disorders, pervasive developmental disorders, control of aggressiveness and impulsiveness and anger, etc. Considering this sensitive period of life followed by intense metabolic and hormonal changes, it is very important to take into account the possibility of unwanted side effects of third generation antipsychotics, e.g., galactorrhea, hyperprolactinemia, menstrual cycle disorders, osteoporosis (girls and adolescents), gynecomastia (boys and adolescents), sexual disorders, and hypogonadism. Both sexes are at an increase risk of obesity, increased values of lipids and fasting glucose, digestive and genitourinary problems. The authors of this review conclude that good therapeutic response and optimal clinical effect can be achieved by making an accurate diagnosis, choice of an appropriate antipsychotic and careful monitoring for adverse reactions. 

Key words: antipsychotics, atypical, young population, adverse reactions

Soc. psihijat., 37 (2009)   212-215 Pregled

Homocistein i psihijatrijski poremećaji

Bjanka Vuksan –Ćusa, Darko Marčinko i Miro Jakovljević

Klinika za psihijatriju, Klinički bolnički centar Zagreb, Zagreb, Hrvatska

Hiperhomocisteinemija se povezuje s bolestima CNS-a. Visoke vrijednosti homocisteina nađene su u bolesnika s različitim vrstama demencije i afektivnim poremećajima, a u zadnje je vrijeme sve više istraživanja uloge homocisteina u psihotičnim poremećajima. Ključni patofiziološki mehanizam kojim se objašnjava uloga homocisteina i niske razine B vitamina u nastanku psihijatrijskih bolesti je poremećaj u reakcijama transmetilacije u CNS-u. Hiperhomocisteinemija je istodobno nezavisni i umjereni rizični faktor za razvoj kardiovaskularnih bolesti što se, pored ostalog,  objašnjava učinkom homocisteina u ubrzavanju procesa aterogeneze.  Kako je hiperhomocisteinemija nezavisni rizični faktor za razvoj psihijatrijskih i kardiovaskularnih bolesti koje su češće u psihijatrijskih bolesnika ili ranije nastaju, moglo bi biti korisno uključiti mjerenje homocisteina u rutinske dijagnostičke postupke, osobito u  psihijatrijskih pacijenata s visokim kardiovaskularnim rizikom.

Ključne riječi: homocistein, psihijatrijski poremećaji, kardiovaskularne bolesti

S U M M A R Y

HOMOCYSTEINE AND PSYCHIATRIC DISORDERS

B. VUKSAN-ĆUSA, D. MARČINKO and M. JAKOVLJEVIĆ

University Department of Psychiatry. Zagreb University Hospital Center, Zagreb, Croatia

      Hyperhomocysteinemia is related to the central nervous system diseases. Elevated levels of serum homocysteine have been found in patients with dementia and affective disorders, but recent studies have also confirmed the role of homocysteine in psychotic disorders. Disturbed transmethylation reactions in the central nervous system caused by low B-vitamin status and hyperhomocysteinemia are linked to the key pathophysiological mechanisms of psychiatric disorders. Hyperhomocysteinemia has emerged as an independent and graded risk factor for the development of cardiovascular disease due to enhanced atherogenesis. Since hyperhomocysteinemia is linked to   psychiatric disorders and cardiovascular diseases that are more prevalent and have earlier onset in psychiatric patients, it could be useful to include fasting serum homocysteine determination in the routine diagnostic work-up, particularly for psychiatric patients with a higher cardiovascular risk.

Key words: homocysteine, psychiatric disorders, cardiovascular risk

Soc. psihijat., 37 (2009)   216-221 Stručni rad

RAD, RADNO MJESTO I PIJENJE ALKOHOLNIH PIĆA

ROBERT TORRE, ZORAN ZORIČIĆ¹ i  ANTO OREŠKOVIĆ¹

Klinika za psihijatriju, Klinička bolnica „Sestre milosrdnice“i ¹Psihijatrijska bolnica Sv.Ivan – Jankomir,

Zagreb, Hrvatska

                Kada prosuđujemo pojavnost alkoholom izazvanih problema među uposlenicima moramo biti svjesni činjenice da je pijenje alkoholnih pića desetljećima bilo sastavnica rada, radnog mjesta i vremena, napose među muškim uposlenicima. Većina osoba s problemom pijenja je zaposlena, tako da je upravo radno mjesto jedno od nosivih poluga prevencije alkoholom uzrokovanih poremećaja. Ipak, unatoč visokoj zastupljenosti uposlenika s problemom pijenja, mali je broj poduzeća i poslodavaca koji su poduzeli ozbiljnije mjere prevencije i pomoći osobama s poremećajima uzrokovanima alkoholom. Štoviše, sukladno prošlogodišnjim izmjenama i dopunama Zakona o zaštiti na radu, poslodavac je postao zakonski obvezan ne tek, kao dosada, samo utvrđivati i sprječavati pijenje na radnom mjestu, već utvrditi postupak provjere alkoholiziranosti svojih uposlenika, ali isto tako pružiti svojim uposlenicima punu informaciju o štetnosti zloporabe alkohola, i još k tome izraditi i provesti među njima program prevencije zloporabe sredstava ovisnosti. Pojavnost pijenja na radnom mjestu među našim uposlenicima u značajnom je raskoraku s tekućom zakonskom regulativom koja ne tolerira nikakvo pijenje ni na radnom mjestu niti u okviru radnog vremena, i ukazuje koliki posao moraju odraditi javnozdravstvne preventivne službe, nadzorne službe zaštite na radu, pa i sustavi tretmana osoba s problemom pijenja, da bi se tekuće stanje barem približilo onom propisanim zakonom.

Ključne riječi: pijenje na radnom mjestu, alkohol, Zakon o zaštiti na radu, programi  pomoći uposlenicima

S U M M A R Y

WORK, WORK PLACE, AND ALCOHOL DRINKING

R. TORRE, Z. ZORIČIĆ and A. OREŠKOVIĆ¹

University Department of Psychiatry, Sestre milosrdnice University Hospital, and ¹Sveti Ivan Psychiatric Hospital, Zagreb, Croatia

      When assessing the prevalence of alcohol related problems among employees, one should be aware of the fact that alcohol drinking has for decades been an integral part of the work, work place and office hours, among male employees in particular. The majority of individuals with drinking problems are employed, thus their work place being one of the main levers of prevention of alcohol induced disorders. However, in spite of the high prevalence of employees with drinking problems, the measures of prevention and help for individuals with alcohol induced disorders have been taken by only few companies and employers. According to the last year’s amendments of the Act on Occupational Safety and Health, the employer is obliged by legal provisions not only to identify and prevent alcohol drinking at work (as it was to date) but also to introduce a procedure to assess the level of alcohol intoxication of the employees, offer them full information on the harmful effects of alcohol abuse, and develop and implement the program of prevention of dependence substance abuse among the employees. There is great discrepancy between the prevalence of alcohol drinking at work and respective legislation which does not tolerate any level of alcohol drinking at work or during office hours. Thus, the public health preventive services, occupational safety surveillance and systems offering treatment for individuals with drinking problems will have to work hard to reduce the gap between the current situation and legal provisions.

Key words: alcohol drinking at work, alcohol related problems among employees, Act on Occupational Safety and                                                 Health, programs of help for employees with drinking problems

Soc. psihijat., 37 (2009)   222- 226                                                                                                                                       Stručni rad

ZAŠTO OSTAJU ZAJEDNO?

prikaz partnerske terapije

VLASTA ŠTALEKAR i SANJA BOROVEČKI-JAKOVLJEV¹

Klinika za psihijatriju - Dnevna bolnica, Klinički bolnički centar Zagreb i ¹Poliklinika Vili, Zagreb, Hrvatska

                Partnerska/bračna psihoterapija usmjerena je na razumijevanje i promjene partnerskog odnosa. U prikazu se koristimo  konceptima teorije objektnih odnosa, attachment-a i dinamsko-analitičkog pristupa. Naslovom želimo zaintrigirati, ali također i ukazati na osnovnu pretpostavku: izbor partnera temelji se na nesvjesnim procesima kojima obje strane ravnopravno doprinose. Uzajamni prigovori, patnje i optužbe „tko je u krivu, a tko u pravu“, ne mogu objasniti narav problema para koji prikazujemo. Ovaj odnos karakteriziraju uzajamne povrede nesvjesnih potreba i svjesnih očekivanja, nedostatak bazičnog povjerenja, poteškoće u održavanju bliskosti i njena nevjera uz njegove stalne dvojbe ostati zajedno ili ne. Premda ispunjeni razočaranjima i sumnjama, očekivanjima koja se ne ostvaruju, nezadovoljstvom i ponavljanim povredama ipak ostaju zajedno nakon brojnih prekida. U bračnoj ili partnerskoj terapiji ne razmatraju se individualne povijesti jednako kao u individualnoj terapiji, iako je njihovo dinamsko razumijevanje nužno za  procjenu nesvjesnih potreba (repeticije, reparacije), koje partnere na svjesnoj razini motiviraju za stvaranje  specifičnih interakcija u odnosu. Stoga  je umješnost balansiranja među tim razinama odnosnog i intrapsihičkog u terapijskom smislu vrlo značajna i zahtjevna.

Ključne riječi: bračna ili partnerska terapija, stilovi attachmenta/ privrženosti, radne hipoteze, teorijski koncepti

S U M M A R Y

WHY THEY STICK TOGETHER? CASE REPORT OF COUPLE THERAPY

V. ŠTALEKAR and S. BOROVEČKI-JAKOVLJEV¹

Day Hospital, University Department of Psychiatry, Zagreb University Hospital Center, and ¹Vili Polyclinic, Zagreb, Croatia

      Couple therapy is focused on the understanding and changes in the couple relationship. In this case report, we use theoretical concepts of the object relations theory, attachment theory and psychoanalytical-dynamic approach. With the title we want to intrigue, but also draw attention to the main presumption that the choice of partner is based on unconscious processes in both individuals. Reproaches, sufferings and accusations on both sides in the couple cannot explain their main problems. They hurt each other, miss basic trust, cannot keep closeness, she cheats him with another man, and he doubts whether or not to stay with her. Although being overwhelmed with disappointments and doubts, they stick together in spite of all these rational reasons for split. Although in couple therapy we do not focus on individual histories, dynamic approach and understanding towards them is crucial for evaluation of the unconscious needs (for repetition or reparation) that lead the couple towards their conscious choices and behavior. Good therapeutic balance between these two levels of functioning, intrapsychic and relational, is crucial.

Key words: couple therapy, attachment styles, working hypothesis, theoretical concepts