Personality dysfunction in opiate addicts on opioid substitution treatment and the risk of HCV infection.

Background: Impulsivity, affective instability, and neglect of oneself and other people's safety as symptoms of personality dysfunction are associated with risky behaviors regarding the transmission of infectious diseases either sexually or by intravenous drug abuse. Objective: The aim of this study was to analyze the association between hepatitis C virus (HCV) infection and personality dysfunction in opiate addicts on opioid substitution treatment. Methods: This was a cross-sectional, observational investigation of patients over 18 years of age who were actively participating in opioid substitution treatment at five centers in Bosnia and Herzegovina. The occurrence of HCV infection was the primary study outcome, and personality functioning, the main independent variable, was assessed using the Severity Indices of Personality Problems (SIPP-118) questionnaire. The association between scores of personality functioning domains items and HCV infection status was determined by binary logistic regression analysis. Results: Patients on opioid substitution therapy with HCV infection more frequently had personality disorders (OR 2.168, 95% CI 1.161-4.05) and were treated longer than patients without HCV infection (OR 1.076, 95% CI 1.015-1.14). HCV infection was associated with lower self-respect (OR 0.946, 95% CI 0.906-0.988), decreased capacity to have enduring relationships with other people (OR 0.878, 95% CI 0.797-0.966), and lower capability to cooperate with others (OR 0.933, 95%CI 0.888-0.98). On the other hand, except for self-respect, other elements of the Identity Integration domain (enjoyment, purposefulness, stable self-image, and self-reflexive functioning), when more functional, increased the risk of HCV infection. Conclusions: Our study demonstrates that opiate addicts on opioid substitution treatment have a higher risk of HCV infection if their personality is dysfunctional, especially in the aspects of self-respect, enduring relationships, and cooperativity. The risk is even higher in addicts who have an established diagnosis of any kind of personality disorder.

Organization of mental healthcare in Bosnia and Herzegovina during coronavirus disease 2019 pandemic.

BACKGROUND: Coronavirus disease 2019 (COVID-19), like any other pandemic, has imposed an unprecedented threat to physical and mental health to all nations, worldwide. There is no enough evidence in the literature in this area. The present study has been done to explore the organization of psychiatric services in Bosnia and Herzegovina (BH) to meet mental health needs of BH citizens during the particular restrictive measures caused by COVID-19 pandemic. MATERIALS: This online survey has been done for BH psychiatric institutions. Data were collected from psychiatric institutions in the mental health network of BH. A total of 38 complete responses have been received. RESULTS: Of 38 study participants, three were the departments of psychiatry in university clinical centers, two were psychiatric hospitals, four were psychiatric wards in general hospitals, 27 were community mental health centers, and two were institutes for alcoholism and drug addiction. During the pandemic, all services functioned on a reduced scale, adhering to measures to protect and self-protect both staff and service users. Protective equipment was provided to staff in some institutions in a timely and complete manner and in some in an untimely and incomplete manner. Consultative psychiatric examinations were mainly performed through telephone and online, where it exists as a standard patient monitoring protocol. The application of long-acting antipsychotics was continuous with adherence to restricted and protective measures. In opiate addiction replacement therapy services, substitution therapy was provided for a longer period to reduce frequent contacts between staff and patients. Individual and group psychotherapy continued in reduced number using online technologies, although this type of service was not administratively regulated. An initiative has been given to regulate and administratively recognize telepsychiatry by health insurance funds in the country. A number of psychological problems associated with restrictive measures and fear of illness have been reported by patients as well as by the professionals in mental healthcare teams. There were no COVID-19-positive patients seeking help from institutions that responded to the questionnaire. In one center, infected people with COVID-19 from abroad sought help through the phone. Only one involuntary hospitalization was reported. The involvement of mental health professionals in the work of crisis headquarters during the design of the COVID-19 pandemic control measures varies from satisfactory to insufficient. Education of staff, patients, and citizens was regular with direct instructions through meetings, press, and electronic media. CONCLUSIONS: During the COVID-19 pandemic in BH, all psychiatric services functioned on a reduced scale, adhering to measures to protect and self-protect staff and service users. All patients who asked for help have been adequately treated in direct inpatient or outpatient mental healthcare or online, despite telepsychiatric services not being recognized in health system in BH. There were neither infected patients nor staff with COVID-19 in the psychiatric institutions who responded in this research. A large-scale, multicenter study needs to be performed to get a broader picture and to guide us for future better service planning and delivery.

The Impact of the Attitudes toward Work on the Affective Status of the Therapists in the Treatment of Addicts.

BACKGROUND: The attitude of health care professionals towards job is determined by the degree of their ability to work with addicts, educational and cultural factors, as well as the psychological profile of their personality, on which depend their emotional response in work with addicts. AIM: To explore the therapist's relationship to job, whether that relationship has an effect on their affective status, and to what extent that relationship can lead to the development of tension (anxiety) during the treatment of opiate addicts. SUBJECTS AND METHODS: The sample consists of members of the multidisciplinary teams of the Institute for Addiction Disorders of Canton Sarajevo (45 in total), of which 11 are physicians, 26 nurses/medical technicians, 4 psychologists and 4 social workers. Employee Attitude Questionnaire (16 questions examining level of information, feelings of insecurity, fatigue, teamwork and job satisfaction) and EMAS-S which has two subscales (for measuring cognitive worry factor and autonomic-emotional anxiety state factor) were used. RESULTS: From baseline, 32 (71%) of respondents have the opportunity to apply their knowledge and skills at workplace, which is proportional to their job satisfaction, reduction of anxiety and uncertainty. A large proportion of respondents 36 (80%) stated that they felt more responsible in their work compared to the beginning of career, which was followed by a decrease in the score on EMAS cognition and emotion subscale, what reflected positively on work efficiency. The degree of satisfaction at the end of the work day, often and almost always, has 60% of respondents. CONCLUSION: Employees who feel satisfaction at work, who improve their knowledge and work in a team, have a better attitude towards work and less anxiety, and achieve better results when working with addicts.

Association of dopamine receptor gene polymorphism and psychological personality traits in liability for opioid addiction.

There is a clear evidence that same psychoactive substance may cause various individual physiological reactions in same environmental conditions. Although there is a general attitude on equal liability to opioid addiction, latest genetic analysis findings imply there are certain quantifiable factors that could lead to elevated individual liability towards development of opioid addiction. The goal of this study was to investigate association of certain personality traits and genetic factors (separately and in combination) with heroin addiction. Total of 200 individuals participated in the study: 100 patients on Metadone Maintenance Treatment (MMT) and 100 age and sex matched healthy volunteers. All were medically examined, interviewed and psychologically evaluated using Eysenck personality questionnaire (EPQ) and genotyped for DRD2 (rs1800497) using PCR-RFLP method. Overrepresentation of certain personality traits (neuroticism, psychoticism and extraversion/ intraversion), together with environemental risk factors such as: upbringing within incomplete families and familial history of psychotropic substances abuse, are associated with high-risk development of opioid addiction.

The effect of psychoactive substances (drugs) on the presence and frequency of oral Candida species and Candida dubliniensis.

THE GOAL: The goal of this study was to determine the effect of psychoactive substances (drugs) on the presence and frequency of oral Candida species and Candida dubliniensis. MATERIALS AND METHODS: For the purpose of achieving the set goals, we chose a sample. Sixty bed-ridden patients from the Institute for Alcoholism and Other Addictions in Sarajevo Canton, both males and females between 18 and 60 years of age, were included in the research and assigned to two different groups (alcohol addicts and opiate addicts). After extensive anamnesis and a clinical examination, samples of oral epithelia were taken for microbiological identification. Two confirmatory methods were used for the identification of Candida species: the blastesis test and cultivation in a chromatophilic medium (Chrom agar). A yeast assimilation test (API test) was used for the identification of non-albicans Candida. A separate test was used to identify Candida dubliniensis (PAL agar). RESULTS: The results of the microbiological analysis confirmed the frequency of Candida albicans (43%) in psychoactive substance addicts, as well as an increase in non-albicans Candida regardless of the type of addiction (34%). The presence of Candida dubliniensis was proven in psychoactive substance addicts (23%) and it was confirmed that the frequency of bacterial adherence of Candida dubliniensis is directly proportional to the duration of the drug-addiction. CONCLUSION: The abuse of psychoactive substances has an effect on the frequency of albicans and non-albicans species of oral Candida. Based on the findings, we have concluded that psychoactive substances (opiates and alcohol) lead to an increase in oral Candida dubliniensis regardless of the type of addictions.

Treatment of addicts in Bosnia and Herzegovina--constraints and opportunities.

Chronology of important historical events in Bosnia and Herzegovina during past two centuries indirectly influenced the incidence and prevalence of different psychoactive substances use and thus the organization of services for the treatment of persons who develop addiction symptoms. The organization of health system in the last war, 1992-1995, suffered enormous damage and the reform process which inevitably followed, included the area of mental health care services and the establishment of network of centers for mental health in the community (CMHC). The centers are functioning within the primary health care almost in whole country, with specialized centers for the prevention and treatment of addicts and the therapeutic communities, which today represents the basic organizational units to help people who have drug related issues. In this paper we will present the possibility of treatment of drug addicts in Bosnia and Herzegovina, from consulting services, psycho-education and early detection of disease, detoxification and substitution programs with Methadone and Suboxone, as well as programs of rehabilitation and resocialization. Although a very complicated political and administrative structure of the country, insufficient financial support, pronounced stigmatization of addicts, insufficient staffing and number of treatment centers are objective obstacles for progress in treatment of addicts, we believe that, with existing resources, these constraints can be converted into new opportunities in terms of improvement of treatment options in the future.

[Paroxysmal psychological disorders--a diagnostic trap]. / Paroksizmalni psihicki poremecaji--dijagnosticka zamka.

UNLABELLED: Paroxismatic psychical disorders, as attacks of panic and anxiety, de-realization, de-personalization, false reconescense phenomena and other are, represent the diagnostic problem. The possibility of mistake is significant, and wrong diagnosis has medical and social implications. The aim was to point out the methodology of the work with these patients. METHOD: From the group of patients with resistant epilepsies, we have separated five patients, which are very instructive. Three of them have been on anti-epileptics for 2.5 up to 4 years (partial complex attacks), two on psycho-pharmacies and one on psycho-therapy (as pseudo-attacks). The complete history of the disease have been taken with all patients, together with simultaneous consultations with psychiatrist, laboratory and cardiology status, EEG registrations, and with three patients the whole-night poly-somnogram (Vrapce), CT and MRI of the brain. RESULTS: Three patients with "resistant epilepsy" did not have epilepsy, but were psychiatric cases, although two patients were partial complex epilepsies (pseudo-attacks before). DISCUSSION: The diagnosis of paroxysmal psychic disorders has to be all-inclusive. It has to have included maximal diagnostic criteria for the epilepsy, together with obligatory consultation (synchronal) with psychiatrist. Some characteristics of epileptic attacks may be the direction-signs: they are short, repeating more or less on stereotype way, accompanied with automatisms, and especially important are post-attack conditions (conditions of confusion). If paroxysms are of less sharp borders, last longer, less stereotype, and especially if there is no post-ictal shows, more probably are psychiatric cases. CONCLUSION: 1. For the exact diagnosis of paroxysm, the overall consideration, the close cooperation between epileptologist and psychiatrist are needed, 2. The maximal diagnostic criteria for epilepsy are conditio sine qua non.

[Characteristics of addictions in Bosnia and Herzegovina a review of prevention programs]. / Osobenosti ovisnosti u Bosni i Hercegovini s osvrtom na program prevencije.

Hazardous and harmful use of alcohol and drugs, accompany human race for centuries, and represents transcultural phenomena as well as one of the problems that still does not have solution. According to consequences that it's causing to individual, family and community it is one of the most severe social problems. Although, international community is investing more and more efforts and money to prevent illicit drug traffic, reduce consumption of alcohol and improve prevention, treatment and rehabilitation of addicts, still some significant results are not reached. War in Bosnia and Herzegovina cause severe injuries to population and left devastation and misery. War crimes are reflected in 200,000 deaths, several thousand wounded and over one million traumatized. Transition societies, as our, are characterized with big social changes such as migrations, urbanization and destruction of traditional social values. Due to this extensive drinking and drug use, as a form of escape from the reality and social difficulties are characteristic of our society and current civilization. It is estimated that currently in B&H exist 10,000 opioid addicts, and 20,000 alcoholics. Rapid incensement in number of addicts, and problems caused by that was the reason why we after the war started with preparations of Preventive Programme with focus on primary prevention. Beside programs that was made on the local levels, during 2002 Federal Programme of prevention was accepted which anticipated activities at all three preventive levels.

[Use of methadone therapy at the Institute for Alcoholism and Drug Addiction in the Canton of Sarajevo]. / Iskustva primjene metadonske terapije u Zavodu za alkoholizam i druge toksikomanije Kantona Sarajevo.

INTRODUCTION: Number of addicts increased in our country, especially after the war, and needed adequate solution of the problem as well as use of the experiences from the other countries that faced before us "epidemy" of addictions. One of the solutions for harm reduction caused by use of opioid substances, primarily heroin, is use of methadone (heptanone), which is a good pharmacological replacement. METHODS: In this paper we have presented one-year experience in application of methadone for detoxification or substitution among the patients in our Institute. This retrospective-prospective study included 104 patients treated by methadone detoxification therapy and 59 patients included in the program of methadone substitution. This study involves analyses of the applied therapy compared to age, gender, profession, and duration of addiction, employment status and other social and demographic indicators. RESULTS: Methadone detoxification therapy. Among all age groups most dominant are addicts age 21-30 years (71%), and some in the age group 30-35 years (18%). Lack of adequate treatment programs, as well as break in continuity of treatment due to the war in our country, caused that we have in our sample 10% patients older than 36 years. Few patients younger than 20 years of age, we can explain with short working age of your department, but even now we can notice the incensement of young addicts number. First contact with the drug our addicts usually have between 13 and 18 years of age (61%), while earliest age of contact was 11. Duration of addiction is usually from 1 up to 9 years (65%), although we cannot neglect the number of addicts who are using the drug more than 10 years (35%). During our work, up to now, we did not have neither one case of HIV infection, which does not means that this disease is not present in the addicts population that we have not tested yet. Number of Hepatitis B and C positive addicts in our sample is in accordance with epidemiological data from other countries. There was 32% Hepatitis B positive, 58% Hepatitis C positive, and 23% Hepatitis B and C positive. Methadone substitution therapy. Among those included in the MST, male patients are most dominant, with average age of 31.4 years. Majority of patients has finished high school, they are unemployed, single, and living with their parents. First contact with drugs they had in average age of 16.4 years, while the duration of use had mean value of 10 years. Initial maintenance doses were between 10 and 50 mg, mean 36.1 mg, and maintenance doses after the two months had mean value of 61.6 mg. Among patients involved in MST, we have noted one HIV positive case, and significantly larger number of patients that are positive on Hepatitis: Hepatitis C 33%, and Hepatitis B and C (34%). CONCLUSIONS: Our experience during the application of both treatment types is positive. This treatment is well accepted by the addicts. The MDT and MST methods provides better functioning, easier follow up and better participation in the social and psychological therapeutic processes, which are conducted at our department. Positive improvement in social functioning. Better motivation for the continuation of treatment in the other institutions (therapeutic community). We did not have any side effects of the treatment in order to stop the therapeutic process. We need continuous education and sensibility of the whole society and political community in order to accept, finance and maintain methadone programs.