Psychiatric Hospital Sveti Ivan

Background/Objectives: To describe a previously unreported compensatory behavior used by an infant with severe bilateral congenital ptosis associated with blepharophimosis syndrome (BPES). Methods: Observational case report of a 4.5-month-old infant with severe bilateral congenital upper eyelid ptosis due to BPES. Results: The infant demonstrated classic compensatory mechanisms, including frontalis overaction and chin elevation, which were insufficient to clear the visual axis. Notably, she repeatedly used the dorsal surfaces of both fists to elevate the upper eyelids simultaneously and maintain fixation on faces. This behavior ceased following bilateral frontalis suspension surgery with silicone rods. Conclusions: In early infancy, severe bilateral ptosis may prompt the emergence of alternative, developmentally constrained compensatory behaviors. The bilateral fist lid-lift appears to represent a visually driven, sensorimotor strategy to clear the visual axis when conventional mechanisms are ineffective. Recognition of this behavior expands understanding of early compensatory responses in congenital ptosis and BPES.

Background/Objectives: Healthy lifestyle behaviors are major contributors to overall health and disease prevention. This cross-sectional study aimed to assess attitude toward a healthy lifestyle and its associations with lifestyle behaviors, body mass index (BMI), excess body weight, sociodemographic characteristics, and self-rated health in adults. Methods: The Attitudes toward a Healthy Lifestyle Questionnaire was administered to 570 Croatian adults between November and December 2025. Multiple linear and binary logistic regression models were used to examine associations between lifestyle behaviors (number of daily meals, sitting time, sleep duration), smoking and e-cigarette use, alcohol consumption, BMI, self-rated health, and attitude toward a healthy lifestyle. Results: The median attitude toward a healthy lifestyle score was 52.0 (IQR = 10), corresponding to 62% of the maximum possible score. A more positive attitude toward a healthy lifestyle was associated with a higher number of daily meals (β = 0.16, p = 0.001), longer sleep duration (β = 0.17, p < 0.001), lower sitting time (β = −0.11, p = 0.010), and lower BMI (β = −0.24, p < 0.001). Smoking was negatively associated with attitude toward a healthy lifestyle (β = −0.18; p < 0.001), while e-cigarette use was associated with fewer daily meals (β = −0.10; p = 0.025). Longer sleep duration increased the odds of excellent self-rated health (OR = 1.31, p = 0.014), and a more positive attitude toward a healthy lifestyle was associated with lower odds of excess body weight (OR = 0.92, p < 0.001). Conclusions: Attitude toward a healthy lifestyle is significantly associated with lifestyle behaviors, BMI, excess body weight, and self-rated health, highlighting the importance of psychological factors in promoting sustainable healthy lifestyles.

Diabetes mellitus and its microvascular complications, including diabetic retinopathy (DR), present significant health challenges. DR is a leading cause of vision impairment and blindness among working-age individuals in developed countries. The prevalence of DR continues to rise, underscoring the need for more precise diagnostic and therapeutic strategies. Due to its multifactorial nature and despite advancements in understanding DR pathophysiology, predicting its onset and progression remains challenging. Traditional screening and treatment methods often fall short of addressing the heterogeneous nature of the disease, underscoring the need for personalised therapeutic strategies. Recent research has highlighted the vital role of genetic biomarkers in the development and progression of DR, paving the way for a precision medicine approach. Personalised eye care in patients with diabetes aims to accurately predict the risk of DR progression and visual loss in real time. A precision medicine approach that utilises genetic biomarkers offers a promising pathway for personalised diagnosis and treatment strategies. Each DR case is distinct in phenotype, genotype, and therapeutic response, making personalised therapy crucial for optimising outcomes. Advancements in genomics, including genome-wide association studies (GWAS) and next-generation sequencing (NGS), have identified numerous genetic markers associated with DR susceptibility and severity. Emerging evidence underscores the critical role of genetic factors, which account for 25–50% of the risk of developing DR. Advances in identifying genetic markers, such as gene polymorphisms and human leukocyte antigen associations, along with the development of targeted drugs, highlight a promising future for personalised medicine in DR. By identifying specific genetic variants associated with DR, we can enhance prevention and early diagnosis, tailor personalised treatment plans, and more accurately predict disease progression. This represents a critical step toward personalised medicine in DR management. Integrating genetic and epigenetic biomarkers into clinical models may transform DR care through earlier diagnosis and precision-guided interventions, gearing it toward precision ophthalmology.

Chronic venous insufficiency (CVI) is a common peripheral vascular condition characterised by the retrograde blood flow in the lower extremities and its consequences such as oedema and other complications. Clinical severity of CVI is assessed according to the CEAP (Clinical, Etiological, Anatomic, and Physiopathologic) classification, which recognises seven grades of increasing clinical severity (C0–C6). Compression therapy aims to accelerate vein, lymph, and microcirculation flow and therefore reduce chronic nonbacterial inflammation and oedema of the extremities. In accordance with the elasticity and stiffness, compression bandages and garments are divided into short-stretch and long-stretch compression materials. Compression therapy is applicable in all stages of CVI. Moreover, compression therapy in conjunction with physical therapy and lifestyle modifications is more effective in reducing oedema, preventing venous distension, and reducing venous wall tension, all while improving calf muscle pump function. Physical therapy in CVI treatment combines everyday lifestyle modifications, physical activity, medical exercise, sports activity, hydrotherapy, and electrotherapy. Therefore, physical therapy is used either for prevention or either for therapeutic purposes in CVI. For grades CEAP C0–C2, preventive measures consist of education and counselling, medical exercise and general fitness, and sports and physical activities. However, for therapy in grades CEAP C3–C6, medical exercise and a specific rehabilitation programme, manual lymphatic drainage and massage, balneotherapy, and electrotherapy are recommended.

ABSTRACT Objective While epilepsy research has largely focused on medical management and clinical outcomes, less attention has been given to the unmet psychosocial, and everyday needs of people with epilepsy (PWE), particularly in low- and middle-income countries. The Global Epilepsy Needs Study (GENS) aims to explore these needs, which are integral to quality of life, by capturing both shared and context-specific experiences. Methods GENS employed a patient-centered approach and mixed-methods design, integrating a cross-sectional survey and semi-structured interviews in 15 countries. The survey, available in 12 languages, captured experiences across 10 life domains (n=5296). Interviews, analysed thematically using a phenomenological approach and Colaizzi’s Method, explored lived experiences in depth (n=75). To ensure meaningful involvement and diverse representation, national patient associations, healthcare professionals, researchers and people with lived experience guided each stage of the research process, from study design to manuscript development. Results Quantitative and qualitative data were integrated using a joint display method. This analysis generated 5 Generalised Themes across all life domains: 1) Managing uncertainty and redefining daily life; 2) Living with risk, social exclusion, and misunderstanding; 3) Challenges in navigating inaccessible systems; 4) Consequences of inaccessible or inadequate information; and 5) Complex epilepsy needs demand more than standard approaches. Significance This first-of-its-kind global study offers a comprehensive picture of the psychosocial and everyday challenges faced by PWE. It establishes a critical evidence base for epilepsy organisations, highlights the need for healthcare systems to adopt holistic, multidisciplinary approaches, and calls on policymakers to invest in systemic reforms that safeguard dignity, inclusion, and life opportunities. Future research should explore the needs of underserved groups, including caregivers, individuals with complex epilepsy, women, and those in low-income or rural settings. Plain Language Summary This study looked at the everyday challenges faced by people with epilepsy in different parts of the world. It showed that many people struggle with fear, stigma, poor access to services, and a lack of clear information and support. Women, people in rural areas, and those in low-income settings often face the greatest challenges. The study calls for better education, more support for caregivers, and improvements across health, work, school, and transport systems. It also shows the need for more research to understand and respond to the real-life needs of people most impacted by epilepsy.

Animal identification is a topic of many studies, with a range of biometric methods currently in use. The cattle muzzle serves as a unique source of biometric traits. The aim of this study was to determine the best method for muzzle visualisation using imprints, the most frequent forms and minutiae points on imprints, and the minimum number of minutiae points required to establish an identity profile. Noseprints of 30 calves were taken on different surfaces and visualised using different methods (white paper and cardboard/ninhydrin solution and glass tile/small particle reagents and ceramic tile/fluorescent powder and glossy photopaper/grey instant or magnetic powder). The imprint of the entire muzzle was photographed and analysed using the Automated Fingerprint Identification System (AFIS) to detect the most frequent forms based on friction ridges and minutiae points. Further mathematical simulation revealed the minimal number of points required for animal identification. The best imprint was obtained on glossy black photopaper with grey instant powder. After analysing the digitised images with the AFIS magnifier, the six forms of beads and ridges in the selected 12 minutiae points were detected, thus creating an identity chart. Computer simulation confirmed that the lowest number of minutiae points necessary for unique animal identification, and 0% possibility of form repetition at points, was nine of the 12 selected points. As a biometric method, the muzzle imprint in combination with AFIS has the potential to be stored on large scale and used internationally, enabling identity control that is not susceptible to the issues involved with other biometric methods.

Cutaneous and oral mucosal adverse events (AEs) are among the most common non-hematologic toxicities observed during breast cancer treatment. These complications arise across various therapeutic modalities including chemotherapy, targeted therapy, hormonal therapy, radiotherapy, and immunotherapy. Although often underrecognized compared with systemic side effects, dermatologic and mucosal toxicities can severely impact the patients' quality of life, leading to psychosocial distress, pain, and reduced treatment adherence. In severe cases, these toxicities may necessitate dose reductions, treatment delays, or discontinuation, thereby compromising oncologic outcomes. The growing use of precision medicine and novel targeted agents has broadened the spectrum of AEs, with some therapies linked to distinct dermatologic syndromes and mucosal complications such as mucositis, xerostomia, and lichenoid reactions. Early detection, accurate classification, and timely multidisciplinary management are essential for mitigating these effects. This review provides a comprehensive synthesis of current knowledge on cutaneous and oral mucosal toxicities associated with modern breast cancer therapies. Particular attention is given to clinical presentation, underlying pathophysiology, incidence, and evidence-based prevention and management strategies. We also explore emerging approaches, including nanoparticle-based delivery systems and personalized interventions, which may reduce toxicity without compromising therapeutic efficacy. By emphasizing the integration of dermatologic and mucosal care, this review aims to support clinicians in preserving treatment adherence and enhancing the overall therapeutic experience in breast cancer patients. The novelty of this review lies in its dual focus on cutaneous and oral complications across all major therapeutic classes, including recent biologic and immunotherapeutic agents, and its emphasis on multidisciplinary, patient-centered strategies.

We aimed to investigate the relationships of ICD-11 personality disorder (PD) severity and five maladaptive personality domains with narcissistic grandiosity and narcissistic vulnerability among 398 Croatian adult psychiatric patients. They completed the following self-report questionnaires: the ICD-11 Personality Disorder Severity Scale, the Personality Assessment Questionnaire for ICD-11, and the Pathological Narcissism Inventory. Narcissistic grandiosity showed meaningful associations with the Disinhibition and Anankastia domains. Conversely, narcissistic vulnerability was significantly more strongly associated with PD severity and the Negative Affectivity domain, and it also showed meaningful associations with the Disinhibition, Anankastia, and Dissociality domains. An even more nuanced picture emerged on the facet-level of pathological narcissism, while some novel findings were obtained pertaining to gender differences in the above-mentioned relations. Future studies utilizing additional multidimensional measures of pathological narcissism and gender-sensitive assessment are warranted.

IntroductionStudies that have investigated the relationship between testosterone and psychiatric disorders in women report inconsistent results. Some studies suggesting that female depression patients have lower serum testosterone levels than healthy controls while others report higher serum testosterone levels in female depression patients. Testosterone has also been found to modulate depression and anxiety symptoms. Social research suggests high androgen levels cause aggressive behavior in men and women and as a consequence may cause depression and possible results with more often hospitalization.ObjectivesThe purpose of this study was to determine whether there is a link between the intensity of psychological symptoms that required hospital psychiatric treatment and the level of testosterone in the blood.MethodsThe research is prospective and includes female patients with established diagnoses of depressive disorder, anxiety-depressive disorder, bipolar disorder (depressive episode) aged 18-65. The patients had their laboratory parameters determined, including sex hormones (testosteron, estrogen, progesterone, FSH, LH and prolactin), filled out a demographic questionnaire and questionnaires: The Suicide Behaviors Questionnaire-Revised (SBQ-R), Generalised Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Matthey Generic Mood Question, Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAMA) i Hamilton Depression Rating Scale (HAMD).ResultsThe preliminary data of the prospective study showed that there was a statistically significant proportion of patients in whom higher testosterone levels are linked with higher number of hospitalizations (rho=0.511, p=0.036).ConclusionsPreliminary results show an association between testosterone levels and frequent psychiatric hospitalizations.Disclosure of InterestNone Declared

Introduction Interpersonal traumas affect women’s ability to rely on their social network to cope, which increases their reliance on maladaptive avoidance coping strategies such as drinking. According to psychodynamic models of trichotillomania hair pulling is a manifestation of unresolved sexual conflicts, disordered attachment, and dissociation from traumatic memories. (Houghton, D. C., Mathew, A. S., Twohig, M. P., Saunders, S. M., Franklin, M. E., Compton, S. N., Neal-Barnett, A. M., &amp; Woods, D. W. (2016). Trauma and trichotillomania: A tenuous relationship. Journal of Obsessive-Compulsive and Related Disorders , 11 , 91-95.) Objectives Evidence suggests that rather than making hair pulling worse, alcohol is often used to avoid negative affect related to hair pulling. It slows the nervous system’s activity and may also be used to reduce the urge to hair-pull. (Grant, J.E., Collins, M., Chesivoir, E. et al. Hazardous Alcohol Use in Trichotillomania. Psychiatr Q 94 , 361–369 (2023)) Methods We present a 43-year-old patient who has been hospitalized several times due to alcohol addiction. She is divorced, has no children, is unemployed, and finished elementary school. The patient reported that she started drinking at high school during weekend parties and gradually her drinking became more frequent. Now she is drinking a liter of vodka a day. Her last hospitalization was after she left a domestic violence shelter for women where she escaped because her partner abused her. After she was placed in the alcoholism ward, the initial psychic examination discovered alopecia. Childhood anamnesis showed sexual trauma at a young age, and she reported that she started to pull her eyelashes in kindergarten after two members of a family sexually abused her. Now she is wearing a wig and she reported that there are areas on her scalp where hair doesn’t grow anymore because she pulled it while she was in a shelter. As she described, pulling her hair gave her a sense of relief from anxiety. Results During hospitalization, her pharmacotherapy was corrected and titrated. She was included in psychotherapy, family therapy, group, and individual psychotherapy. The therapeutic procedures applied have improved her mental condition. She has been advised to continue outpatient psychiatric treatment, to regularly use pharmacotherapy, and to attend family therapy and rehabilitation club. Conclusions There is a clear need for future clinical studies not only in the area of trichotillomania’s relationship to substance use disorders but also in trauma coping mechanisms so we can truly understand how people adapt to and recover from trauma. Disclosure of Interest None Declared