Publications (6)0 Total impact

  • Department of Forensic Psychiatry · Neuropsychiatric Hospital »Dr. Ivan Barbot« · Popovača · Croatia · tija.zarkovic-palijan@sk.t-com.hr
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    ABSTRACT: Catechol-O-methyl transferase (COMT) is an enzyme involved in the degradation of dopamine. The most commonly examined polymorphism within the COMT gene is Val108/158Met polymorphism, which results in three to fourfold difference in COMT enzyme activity. It is particularely important in prefrontal cortex, since COMT activity is the most important regulator of the prefrontal dopamine function. Given the association between schizophrenia and decreased dopamine activity in the prefrontal cortex, it is not surprising that Val108/158Met polymorphism is among the most extensively investigated polymorphisms in schizophrenia. According to different studies, Val allele may be a small risk factor for schizophrenia. There is also some evidence that Val108/158Met polymorphism influences the age of onset of schizophrenia, cognitive function, severity of psychotic symptoms, as well as efficacy and adverse events of antipsychotics. Heterogenity of patient population has undoubtedly influenced the results of these studies. Interaction of Val108/158Met polymorphism with other genes and environmental factors is an important avenue for future research.
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    ABSTRACT: Violence is an important social problem. Violence in the community has important social relevance for the political, criminal justice, and health care systems. Studies of homicide offenders have suggested a high prevalence of neurologic dysfunction due to organic brain damage such as traumatic brain injury, epilepsy and dementia have been observed to exhibit excessive violence. Moreover, violence in the mentally ill can be viewed as an important medical and mental health problem with significant implications for forensic psychiatry and the community. Although numerous previous studies showed that rate of violent behavior in the community is not much higher in patients with serious mental disorders (schizophrenia) than in healthy controls, that rate is substantially higher in patients with psychiatric comorbidity and substance abuse. A high proportion of patients in forensic psychiatric facilities are diagnosed with comorbidity, most often with schizophrenia, paranoid psychosis, organic brain syndrome, various personality disorders and comorbid substance abuse. These patients represent a high risk group for violence within forensic psychiatric facilities, and repetitive violent behavior in the community. Understanding the neurobiological basis of aggressive behavior clearly has important social and clinical implications. By introduction of neuroimaging studies (MRI, fMRI, PET, SPECT) as a useful tool in forensic psychiatry, the neurobiological aspect of violence is better understood. Previous studies have shown that individuals with frontotemporal brain dysfunction are frequently displaying antisocial behavior (disinhibition, impulsivity, lack of empathy) that justify the diagnosis of "acquired sociopathy/psychopathy”. A correlation between the potential for impulsive aggression mediated by limbic brain structures, and the control of the aggression by frontotemporal brain regions has been shown. The individuals with such brain dysfunction have an increased risk of violent behavior and scored high on the Webster’s and Hare’s violence risk assessment scale. This article reviews the relationship between psychiatric comorbidity, violence risk assessment and neuroimaging in forensic psychiatry and showing the useful directions for future research, screening and prevention of violent behavior among mentally ill criminal offenders.
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    ABSTRACT: The concept of personalized drug therapy on the basis of genetic investigations has become a major issue in psychopharmacology. Pharmacogenetic studies have focused on polymorphisms in liver cytochrome P450 isoenzymes that metabolize many antidepressant and antipsychotic medications. The most significant results are the association between drug metabolic polymorphisms of cytochrome P450 with variations in drug metabolic rates and side effects. Additionally, polymorphisms in dopamine and serotonin receptor genes are repeatedly found associated with response phenotypes, probably reflecting the strong affinities that most antipsychotics display for these receptors. The contribution of kinetic factors to the clinical outcome of antipsychotic treatment has a strong evidence base. Genetic tests for the pretreatment prediction of antipsychotic response have obvious implications for the selection of most appropriate drug and dose and contribute for the optimization of antipsychotic treatment. The pretreatment determination of individual’s drug metabolic rates by CYP genotyping is the leading field. This review summarizes the present knowledge of associations between cytochrome P450 isoenzymes and the efficacy and side effects of antipsychotics.