V. Folnegović-Šmalc

Psihijatrijska bolnica Rab, Rabaz, Istarska, Croatia

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Publications (51)49.91 Total impact

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    ABSTRACT: It is assumed that stress-related changes in the endocrine and immune systems are key mediators involved in the development of diseases associated with posttraumatic stress disorder (PTSD). Evidence suggests that those changes might be related to the duration of PTSD. The aim of our study was to investigate the differences in selected endocrine- and immune-related variables between PTSD patients and control subjects, and whether these differences persist over time. We assessed 39 Croatian war veterans with PTSD and 25 healthy volunteers (civilians without traumatic experience), all men, at two time points separated by 5.6 years (median; interquartile range: 5.4-6.3). Cortisol and prolactin levels were measured by radioimmunoassays while interleukin-6 and tumor necrosis factor-α were determined by enzyme-linked immunosorbent assays. Immune function was assessed by in vitro natural killer cell cytotoxicity (NKCC). Lymphocyte counts, immunophenotype and intracellular glucocorticoid receptor expression in various lymphocyte subsets were determined by three-color flow cytometry. At the first assessment, moderate to large effect size estimates of differences between patients and controls were observed for most of the measured variables. Only prolactin levels and lymphocyte counts remained significantly elevated in PTSD patients at the second assessment with low to moderate effect size estimates of differences between patients and controls in other variables. Observed endocrine- and immune-related changes in PTSD over time may depend on the duration of the allostatic load posed by the disorder and its impact on interactions between the endocrine and immune systems involved in stress response.
    Full-text · Article · Feb 2011 · NeuroImmunoModulation
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    ABSTRACT: Several abnormalities, including lower histamine levels in brain, elevated serum histamine and degeneration of histaminergic neurons in tuberomammillary nucleus, were described in the histaminergic system of patients with Alzheimer's disease (AD). Histamine is a central neurotransmitter with several functions in brain including regulation of memory, cognition, locomotion, and is degraded in part by histamine N-methyltransferase (HNMT). A common Thr105Ile polymorphism within HNMT gene results in decreased enzyme activity. The Thr105Ile polymorphism was associated with Parkinson's disease, essential tremor, attention-deficit hyperactivity disorder (ADHD), asthma and alcoholism, thus we tested possible association of HNMT functional polymorphism with AD. We have tested 256 AD cases and 1190 healthy controls of Croatian origin. Thr105Ile polymorphism was determined by TaqMan RT-PCR Genotyping Assay and EcoRV digestion. Prevalence of functional HNMT polymorphism among all tested groups was similar and frequency of less active Ile105 variant was 11.5% among AD patients and 13.4% for healthy controls (p=0.26, X(2)=1.25). Our results indicate lack of the association of HNMT Thr105Ile functional polymorphism with Alzheimer's disease.
    Full-text · Article · Feb 2011 · Neuroscience Letters
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    Full-text · Article · Jan 2011 · European Psychiatry
  • E. Radonić · M. Radoš · P. Kalember · M. Bajs-Janović · V. Folnegović-Šmalc · N. Henigsberg
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    ABSTRACT: The reduction of hippocampal volume was frequently reported in schizophrenia, but not in bipolar disorder. This volume reduction is associated with clinical features of schizophrenia, in particular with working and verbal memory impairments. Schizoaffective disorder, as a specific disorder sharing clinical features of both schizophrenia and bipolar disorder is rarely analyzed as a separate disorder in neurobiological studies. The aim of this study was to compare hippocampal volumes in separate groups of patients with schizophrenia, schizoaffective and bipolar disorder. Hippocampal volumes were estimated using high resolution magnetic resonance imaging in 60 subjects, 15 subjects in each patient and one healthy volunteer (control) group. There were no significant differences in hippocampal volume between bipolar disorder and control group. Hippocampal volume was statistically significantly reduced in the group of patients with schizophrenia and schizoaffective disorder, compared to either bipolar disorder or control group, thus supporting the hypothesis that hippocampal volume reduction could be considered as a possible neurobiological basis for clinical aspects of schizophrenia and schizoaffective disorder associated with working and verbal memory impairment.
    No preview · Article · Jan 2011 · Collegium antropologicum
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    ABSTRACT: Introduction and aim: Posttraumatic stress disorder (PTSD) is associated with increased medical morbidity, particularly from the autoimmune and cardiovascular diseases. Changes in the endocrine and immune system are key mediators in this process. The aim of our study was to investigate weather hormones (cortisol and prolactin), proinflammatory cytokines (interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)), components of HPA-axis (lymphocyte expression of glucocorticoid receptor (GR)), immune function (natural killer cell cytotoxicity) and peripheral blood percentages of various lymphocyte subpopulations (T cells, helper T cells, cytotoxic T cells, B cells and natural killer cells) change in patients with posttraumatic stress disorder over time.
    No preview · Conference Paper · Jun 2009
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    Slađana Štrkalj Ivezić · Vera Folnegović-Šmalc · Ninoslav Mimica
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    ABSTRACT: Kako bi se dijagnosticirao neki od anksioznih poremećaja – generalizirajući anksiozni poremećaj, agorafobija, socijalna fobija, panični poremećaj ili opsesivno-kompulzivni poremećaj – potrebno je utvrditi prisutnost klinički značajne anksioznosti koja se javlja kontinuirano više mjeseci (opći anksiozni poremećaj), u definiranim situacijama (fobija), epizodično u paničnim napadajima (panični poremećaj) i prisutnost opsesivnih i prisilnih misli u razdoblju od najmanje sat vremena dnevno (opsesivno-kompulzivni poremećaj). Anksioznost mora biti primarna, a diferencijalno dijagnostički treba isključiti druge psihičke poremećaje, druge tjelesne bolesti i lijekove koji mogu imati simptome anksioznosti kao nuspojavu
    Full-text · Article · Jan 2007
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    Ninoslav Mimica · Slađana Štrkalj Ivezić · Vera Folnegović-Šmalc
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    ABSTRACT: Suvremeno liječenje anksioznih poremećaja uključuje psihofarmakološko liječenje, psihoterapiju i druge oblike liječenja, samostalno ili u kombinaciji. Za liječenje socijalne fobije mnogi smatraju da najbolje rezultate daje kombinacija psihološkog i farmakološkog tretmana, kao prvi izbor u liječenju paničnog poremećaja koriste se antidepresivi iz skupine selektivnih inhibitora ponovne pohrane serotonina (SIPPS), dok su to kod općeg anksioznog poremećaja antidepresivi iz skupine SIPPS i SNRI. Iako su na raspolaganju sigurni i učinkoviti lijekovi za sve anksiozne poremećaje, i nadalje je bitno svakog bolesnika adekvatno i što prije dijagnosticirati, te procijeniti koja je terapijska strategija za njega najbolja
    Full-text · Article · Jan 2007
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    N. Mimica · D. Mück-Šeler · N. Pivac · M. Mustapić · V. Folnegović-Šmalc
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    ABSTRACT: Background and Purpose: Post mortem brain studies indicated that serotonin (5-HT) could be involved in the etiology of Alzheimer's disease (AD). The aim of the study was to determine platelet 5-HT concentration and platelet monoamine oxidase type B (MAO-B) activity in patients with early- and late-onset AD and in healthy subjects. Subjects and Methods: The diagnosis of the probable Alzheimer's disease (NINCDS-ADRDA criteria) was established according to the ICD-10 and DSM-IV-TR criteria. Cognitive function was evaluated using Mini Mental Status Examination (MMSE). The study included 52 patients with AD (23 men; 29 women) and 75 healthy controls (36 men; 39 women). The symptoms of early-onset AD and late-onset AD were observed in 27 and 25 AD patients, respectively. Platelet 5-HT concentration and platelet MAO-B activity were determined spectrofluorimetrically. Results: Patients with early-onset AD had similar platelet 5-HT values as sex-matched patients with late-onset AD and healthy controls. Significant difference in platelet MAO-B activity was observed between groups, with higher platelet MAO-B activity in male and female patients with AD than in corresponding healthy controls. A significant difference in platelet MA O-B activity was found between patients with early- and late-onset AD and healthy controls. The highest values of platelet MAO-B activity were found in both male and female patients with late-onset AD when compared to corresponding healthy controls. Conclusion: The results from our preliminary, ongoing study, support the presumption that platelet MAO-B activity could be used as a biological marker for different categories of AD.
    Full-text · Article · Jun 2005 · Periodicum Biologorum
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    N. Mimica · S. Ivezic · S. Uzun · O. Kozumplik · M. Lokas · V. Folnegović-Šmalc
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    ABSTRACT: Most psychotropic drugs (antidepressants, antipsychotics, mood stabilizers, anxiolytic and others) can induce sexual dysfuncton. Psychotropic-induced sexual dysfunctions should be recognized and treated as soon as possible, because they can significantly influence the quality of life of each patient, and are considered as major reason for non-compliance, which can lead to progression and relapse of the disease.
    Full-text · Article · Jan 2005
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    ABSTRACT: Depressive disorders are among the most frequently reported mental disorders with the current prevalence of 5 to 10%, lifetime prevalence of up to 18%, and lifetime risk of 20 to 30%. According to the Global Burden of Disease Study for 96 most frequent diseases, based on DALYs for all ages, unipolar depressive disorder ranks fourth and it is anticipated to rank second in 2020. Based on YLDs (Years Lived with Disability), unipolar depressive disorder, with 11.9%, is the most frequent cause of disability. In 2002, Croatia recorded 3 755 hospitalizations and 136 272 days of hospital treatment due to depressive disorders. Consequently, depressive disorders rank third in the group of mental disorders by the number and duration of hospitalization and they account for 9.7 and 7.6%, respectively. In the period from 1995 to 2002, both the total hospitalization number and rate and the hospitalization number and rate by gender showed an increasing trend with some oscillations. The hospitalization rate in 1995, 1996, 1999 and 2002 was 54.6, 88.1, 75.7, 89.4 and 84.6/100 000, respectively. The number of hospitalizations of women was higher than that of men (1.4-2.5:1). The hospitalization rate for both genders was the highest in the age group of 40 to 59. Depressive disorders represent one of public health priorities. Based on projections, the programs for mental health protection should be intensified.
    Full-text · Article · Jan 2004
  • N. Henigsberg · V. Folnegović-Šmalc
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    ABSTRACT: Pharmacogenetics, and particularly pharmacogenomics, are new scientific disciplines whose initial results hold promise that the homogeneous groups with respect to the expected therapeutic response will be recognized among people suffering from depression, which would enable its more efficient treatment. It is clear that the therapeutic response is a result of complex genetic effects, and not only of one gene. Therapeutic response is affected not only by genetic polymorphisms, but also by variations in gene expression and post-translational modifications of proteins under the influence of numerous factors, e.g. dose, food, interactions with other substances. Although pharmacogenetic or even pharmacogenomic studies alone are not expected to completely elucidate the variability in the therapeutic response, the establishment of at least some causes of this variability, which is under a direct genetic influence, would significantly contribute to a more reliable assessment of expected therapeutic response and considerably increase a currently low share of patients responding to antidepressant therapies. For the most part, the variability in the therapeutic response can be explained only by further transcriptomic and proteomic research that is, currently, in the early phase of development.
    No preview · Article · Jan 2004
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    N. Mimica · V. Folnegović-Šmalc · S. Uzun · G. Makarić
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    ABSTRACT: Although many classifications are currently used in psychiatry, two of them are definitely the most important: ICD-10 of the World Health Organisation (WHO) and DSM-IV of the American Psychiatric Organisation. While ICD-10 has to be used in everyday clinical practice, the American classification is more popular in psychiatry. The diagnosis of depressive behavior according to ICD-10 includes depressive episode (F32), recurrent depressive disorder (F33) and dysthymia (F34.1). The diagnosis of depressive episode, either initial or recurrent, is made when all criteria given in the classification are met, irrespective of the circumstances leading to the occurrence of depressive disorder. The article provides a review of measuring instruments used in the diagnosis and evaluation of depressive disorders. The measuring instruments are used to a large extent in psychiatry, they are indispensable in all types of psychiatric clinical research and most of them are increasingly used in routine clinical practice.
    Full-text · Article · Jan 2004
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    ABSTRACT: Depressive disorders are currently one of the most frequent mental diseases whose incidence has been continuously increasing since the last century. Epidemiological studies show that every fifth woman and every tenth man has experienced at least one serious depressive episode in a lifetime. In addition to the loss of joie de vivre, the WHO data show that depressive disorders are one of the most frequent causes of incapacity for work worldwide. The abovementioned leads to the conclusion that depression has actually become a public health problem. On the other hand, some ten years ago only psychiatrists treated depression. However, due to its increasing prevalence, general practitioners and family physicians have become first-line physicians in the treatment of depression. Consequently, practical treatment guidelines are needed in everyday work.
    Full-text · Article · Jan 2004
  • Neven Henigsberg · Vera Folnegović-Šmalc
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    ABSTRACT: Pharmacogenetics, and particularly pharmacogenomics, are new scientific disciplines whose initial results hold promise that the homogeneous groups with respect to the expected therapeutic response will be recognized among people suffering from depression, which would enable its more efficient treatment. It is clear that the therapeutic response is a result of complex genetic effects, and not only of one gene. Therapeutic response is affected not only by genetic polymorphisms, but also by variations in gene expression and post-translational modifications of proteins under the influence of numerous factors, e.g. dose, food, interactions with other substances. Although pharmacogenetic or even pharmacogenomic studies alone are not expected to completely elucidate the variability in the therapeutic response, the establishment of at least some causes of this variability, which is under a direct genetic influence, would significantly contribute to a more reliable assessment of expected therapeutic response and considerably increase a currently low share of patients responding to antidepressant therapies. For the most part, the variability in the therapeutic response can be explained only by further transcriptomic and proteomic research that is, currently, in the early phase of development.
    No preview · Article · Jan 2004
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    ABSTRACT: This article shows the classification of antidepressants that is mainly based on their historical development: from classical (tricylic and tetracyclic) non-selective antidepressants and monoamine oxidase inhibitors (MAOIs) to selective serotonin reuptake inhibitors (SSRIs) and antidepressants with dual action. The theories of neuroplasticity have been only mentioned since they are not widely used in pharmacotherapy. As this text is intended for Croatian physicians, a detailed description of antidepressants mainly includes the drugs registered in Croatia. Of course, this neither reflects the authors' opinion about the efficacy or tolerability of unregistered antidepressants nor does it mean that they would not like to have some of these drugs available for their patients. As far as its practical implementation is concerned, this article can also serve as a manual of pharmacotherapy for depressed patients. The need for individual and rational approach and the following principles should be considered: the treatment of patients with mild to moderate depression falls within the responsibility of general practitioners, while the treatment of patients with serious depression and suicidality falls within the responsibility of psychiatrists. Therapeutically resistant patients should be referred to relevant subspecialists. The treatment of depression is primarily carried out with antidepressants. In addition to antidepressants, it is often important to coadminister sedatives/hypnotics because some time is needed for antidepressants to start acting in order to avoid sleepless nights and thus alleviate suffering and increase patient compliance.
    Full-text · Article · Jan 2004
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    [Show abstract] [Hide abstract]
    ABSTRACT: This article shows the classification of antidepressants that is mainly based on their historical development: from classical (tricylic and tetracyclic) non-selective antidepressants and monoamine oxidase inhibitors (MAOIs) to selective serotonin reuptake inhibitors (SSRIs) and antidepressants with dual action. The theories of neuroplasticity have been only mentioned since they are not widely used in pharmacotherapy. As this text is intended for Croatian physicians, a detailed description of antidepressants mainly includes the drugs registered in Croatia. Of course, this neither reflects the authors’ opinion about the efficacy or tolerability of unregistered antidepressants nor does it mean that they would not like to have some of these drugs available for their patients. As far as its practical implementation is concerned, this article can also serve as a manual of pharmacotherapy for depressed patients. The need for individual and rational approach and the following principles should be considered: the treatment of patients with mild to moderate depression falls within the responsibility of general practitioners, while the treatment of patients with serious depression and suicidality falls within the responsibility of psychiatrists. Therapeutically resistant patients should be referred to relevant subspecialists. The treatment of depression is primarily carried out with antidepressants. In addition to antidepressants, it is often important to coadminister sedatives/hypnotics because some time is needed for antidepressants to start acting in order to avoid sleepless nights and thus alleviate suffering and increase patient compliance.
    Full-text · Article · Jan 2004
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    S. Uzun · O. Kozumplik · N. Mimica · G. Makarić · V. Folnegović-Šmalc
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    ABSTRACT: Clinical investigations and clinical practice are oriented on finding efficacious antidepressants with side-effect profile that would not influence the patients' quality of life. The patients should be warned of the possibility of side-effects' occurence in order to recognize and treat these side effects as soon as possible. Extrapyramidal side-effects (EPS) including parkinsonism, dystonia, akathisia and tardive dyskinesia as the most difficult manifestation of EPS, can occure during therapy with antidepressants. Also, weight gain, different metabolic changes, changes in electrocardiogram and cardiovascular changes, as well as sexual side-effects can occure during therapy with antidepressants. In older patients antidepressants should be used in lower doses, titrated as slow as possible and regularly monitored.
    Full-text · Article · Jan 2004
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    Suzana Uzun · Oliver Kozumplik · Ninoslav Mimica · Gordan Makarić · Vera Folnegović-Šmalc
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    ABSTRACT: Clinical investigations and clinical practice are oriented on finding efficacious antidepressants with side-effect profile that would not influence the patients’ quality of life. The patients should be warned of the possibility of side-effects’ occurence in order to recognize and treat these side effects as soon as possible. Extrapyramidal side-effects (EPS) including parkinsonism, dystonia, akathisia and tardive dyskinesia as the most difficult manifestation of EPS, can occure during therapy with antidepressants. Also, weight gain, different metabolic changes, changes in electrocardiogram and cardiovascular changes, as well as sexual sideeffects can occure during therapy with antidepressants. In older patients antidepressants should be used in lower doses, titrated as slow as possible and regularly monitored.
    Full-text · Article · Jan 2004
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    V. Hrabak-Žerjavić · M.S. Radić · V. Folnegović-Šmalc · N. Mimica
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    ABSTRACT: Depressive disorders are among the most frequently reported mental disorders with the current prevalence of 5 to 10%, lifetime prevalence of up to 18%, and life-time risk of 20 to 30%. According to the Global Burden of Disease Study for 96 most frequent diseases, based on DALYs for all ages, unipolar depressive disorder ranks fourth and it is anticipated to rank second in 2020. Based on YLDs (Years Lived with Disability), unipolar depressive disorder, with 11.9%, is the most frequent cause of disability. In 2002, Croatia recorded 3 755 hospitalizations and 136 272 days of hospital treatment due to depressive disorders. Consequently, depressive disorders rank third in the group of mental disorders by the number and duration of hospitalisation and they account for 9.7 and 7.6%, respectively. In the period from 1995 to 2002, both the total hospitalization number and rate and the hospitalization number and rate by gender showed an increasing trend with some oscillations. The hospitalization rate in 1995, 1996, 1999 and 2002 was 54.6, 88.1, 75.7, 89.4 and 84.6/100 000, respectively. The number of hospitalisations of women was higher than that of men (1.4-2.5:1). The hospitalization rate for both genders was the highest in the age group of 40 to 59. Depressive disorders represent one of public health priorities. Based on projections, the programs for mental health protection should be intensified.
    Full-text · Article · Jan 2004
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    G. Makarić · V. Folnegović-Šmalc · N. Mimica · S. Uzun · S. Ivezić · O. Kozumplik
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    ABSTRACT: Depressive disorders are currently one of the most frequent mental diseases whose incidence has been continuously increasing since the last century. Epidemiological studies show that every fifth woman and every tenth man has experienced at least one serious depressive episode in a lifetime. In addition to the loss of joie de vivre, the WHO data show that depressive disorders are one of the most frequent causes of incapacity for work worldwide. The abovementioned leads to the conclusion that depression has actually become a public health problem. On the other hand, some ten years ago only psychiatrists treated depression. However, due to its increasing prevalence, general practitioners and family physicians have become first-line physicians in the treatment of depression. Consequently, practical treatment guidelines are needed in everyday work.
    Full-text · Article · Jan 2004

Publication Stats

88 Citations
49.91 Total Impact Points

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Institutions

  • 2011
    • Psihijatrijska bolnica Rab
      Rabaz, Istarska, Croatia
  • 1998-2011
    • University of Zagreb
      Zagrabia, Grad Zagreb, Croatia
  • 2009
    • Klinika za psihijatriju Vrapče
      Zagrabia, Grad Zagreb, Croatia