Diagnostic psychiatric and somatic comorbidity in patients with depression in the Western Balkan countries.

INTRODUCTION: This paper aims to examine the frequency and significance of diagnostic comorbidity of psychiatric disorders and somatic diseases in a sample of patients with depression as well as present current psychopharmacological treatment of the patients in the sample. METHODS: The subjects in this study sample were 489 patients from the four Western Balkan countries with current primary diagnosis of major depression according to ICD 10. Comorbid psychiatric disorders and non-psychiatric illnesses were noted according to ICD 10 criteria during the diagnostic interview and analysed later. Additionally, the pharmacological treatment (existing and newly introduced) for each patient was noted and analysed later. RESULTS: At least one comorbid psychiatric disorder was present in 72.5% of patients. The most frequent were anxiety disorders (53.6%), specifically generalized anxiety disorder (20.2%); non-organic sleep disorders (50.7%), specifically insomnia (48.4%); and sexual dysfunctions (21.4%), specifically lack of sexual desire (20.2%). Comorbidity with any non-psychiatric illness was present in 80.3% of patients. The most frequent were circulatory system diseases (55.9%), specifically hypertension (45.9%); endocrine, nutritional and metabolic disorders (51.3%), specifically hyperlipidaemia (24.0%); and other non-psychiatric disorders (60.7%), specifically low back pain (22.7%). All patients received pharmacological treatment with different medications. Most patients received monotherapy or combination therapy of antidepressants, anxiolytics, antipsychotics and antiepileptics. The most frequently used antidepressants were escitalopram, sertraline, and duloxetine. The most frequently used anxiolytics were alprazolam and diazepam, the most used antiepileptic was pregabalin, and the most used antipsychotics were olanzapine, quetiapine, and aripiprazole. CONCLUSION: The results of the study confirm the results of previous research studies about the high prevalence of psychiatric and non-psychiatric comorbidities in patients with depression that were conducted in the past. It would be important if future studies could prove the importance of those comorbidities on clinical severity, choice of treatment, and its outcome in patients with depression.

Bosnian Paternal War Orphans: Mental Health in Postwar Time.

ABSTRACT: More research on the medium- and long-term effects of childhood exposure to war, including orphanhood, is needed. We compared 50 orphans 1 who lost their father during the war in Bosnia and Herzegovina (1992-1995) and 50 age- and sex-matched adolescents from two-parent families during 2011-2012 in terms of sociodemographic characteristics, behavioral/emotional problems, depression, resilience, maternal mental health, and perceived social support. The two groups differed on sociodemographic factors, that is, number of children, family composition, income, school grades, and refugeehood. Paternal war orphans did not differ in terms of adolescent mental health and resilience from their nonorphaned peers, controlling for sociodemographic variables. The mothers of orphans had comparably more posttraumatic psychopathology. As for perceived resources for social support, orphans identified those comparably more often among distant relatives and in the community, that is, religious officials and mental health professionals, and less often among siblings, paternal grandparents, paternal and maternal uncles/aunts, school friends and teachers. Our findings suggest that contextual factors may play an important role in orphans' postwar mental health.

Psychiatric Morbidity Among Older Hospitalized Patients.

Background: Globally, life expectancy is increasing, leading to an equal proportion of elderly and young individuals, which carries extensive implications. In Bosnia and Herzegovina (BiH), the average age at death in 2021 was 77 years, positioning BiH in the middle of the global list of average life expectancy. Current studiesinvestigate whether the prevalence of psychiatric disorders increases or decreases with age, but results are inconsistent regarding the role of age.There is no prior research on mental disorders in the elderly population in BiH. The experience of the previous war in BiH and the post-war complex "transitional period" have been associated with specific challenges to the mental health of this population, inspiring our research topic. Objective: The aim of this study was to investigate the psychiatric morbidity in hospitalized individuals aged≥55 years. Methods: The sample consisted of all patients over age 55 treated at the Department of Psychiatry in Tuzla between January 2018 and December 2020 (N=637), divided into four age categories. Data were obtained from medical records, and for research purposes, a specific questionnaire was constructed. Results: The predominant psychiatric morbidity stemmed from the category of affective disorders, most common within the "55-64 years" age group, while organic mental disorders were more prevalent in other age groups.Substance use disorders were present in patients aged "55-64 years", with a sharp decline in their prevalence in older age. Female participants had a significantly higher prevalence of affective, psychotic, neurotic, and stress-related disorders, whereas male participants exhibited an increased prevalence of organic mental and substance use disorders. Conclusion: In total sample, the most prevalent diagnoses belong to the category of affective disorders. Female were most frequently diagnosed with affective disorders, whereas organic mental disorders and substance use disorders prevail in male.

Comorbidities in Alcohol Use Disorders in Tuzla Canton Area - Bosnia And Herzegovina.

INTRODUCTION: Previous research has shown the simultaneous presence of health diseases and alcohol use disorder (AUD). This research emphasizes the importance of individual diseases, the simultaneous presence and connection of different diseases, which creates the conditions for more adequate treatment of patients with AUD. Determine somatic, neurological and psychiatric diseases in patients with AUD in the Tuzla Canton (TK) in the period from 01.01.2011. to 31.12.2015. SUBJECTS AND METHODS: A retrospective study on the systematic cause of 1,863 patients with AUD recorded in the TK health system. RESULTS: Among 1004 (53.9%) patients with AUD, somatic diseases were present; in men: arterial hypertension 573 (31.7%), alcoholic liver disease 269 (14.9%), diabetes mellitus 211 (11.7%); and in women: arterial hypertension 27 (49.1%), diabetes mellitus 27 (49.1%), elevated lipoproteins 3 (5.5%); alcoholic liver disease 1 (1.8%) and anemia 1 (1.8%). Among 1196 (64,2%) patients with AUD, neurological diseases were present; in men: cognitive impairment 627 (34.7%), post-stroke condition 418 (23.1%), polyneuropathy 269 (14.9%); and in women, post stroke condition 28 (50.9%). Psychiatric comorbidity was determined in 1619 (86.9%) patients with AUD; in men: depressive disorder 806 (44.6%), personality disorder 660 (36.5%), while nicotine addiction 27 (1.5%) and dementia 13 (0.7%) were least present; in women: personality disorder 33 (60.0%), neurotic disorder 27 (49.1%), depressive disorder 22 (40.0%). The largest number of patients with somatic (787 or 42.25%), neurological (939 or 50.40%) and psychiatric comorbidity (939 or 50.40%) belonged to the age group 55-64.9 years. CONCLUSION: Slightly more than half of the patients with AUD were diagnosed with somatic diseases, almost two thirds were diagnosed with neurological diseases and with more than four fifths of patients were diagnosed with psychiatric diseases. Of the somatic diseases the most common ones were, arterial hypertension, diabetes mellitus, and alcoholic liver disease; from neurological diseases: cognitive impairment, post-stroke condition and polyneuropathy; and the most common of psychiatric illnesses were depressive disorder and personality disorder. The largest number of patients are in the ages of 55-64.9.

Gambling from Seven Perspectives.

In recent decades, it has been recognized that certain behaviors resemble addictions to alcohol and other psychoactive substances (PAS). Based on the results of research for such behaviors, many authors have found that it is justified to consider them addictions not related to PAS or "behavioral" addictions and that in the classifications of mental disorders should be in the same group with addictions related to PAS. Compulsive activities that may include gambling, Internet use, playing video games, sex, eating, and shopping based on epidemiological and neurobiological characteristics have similarities to PAS addictions. Recognition of clinical and neurobiological similarities between the described behaviors and behaviors related to PAS use resulted in the inclusion of gambling disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and online gaming disorders are classified as conditions for further research. In the 11th revision of the International Classification of Diseases, gambling and gaming disorders are involved in behavioral addictions. Authors presented problem of gambling through sevne perspectives.

Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice.

BACKGROUND: The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations. METHODS: The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the "EPA Ambassadors", on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19. RESULTS: While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients and for inpatient admission, assessments and treatment for people with mental disorders. Compared to previous months, the mean number of patients treated by psychiatrists in outpatient settings halved in April 2020. In the same period, the number of mentally ill patients tested for, or developing, COVID-19 was low. In most of countries, traditional face-to-face visits were replaced by online remote consultations. CONCLUSIONS: Based on our findings we recommend: 1) to implement professional guidelines into practice and harmonize psychiatric clinical practice across Europe; 2) to monitor the treatment outcomes of patients with COVID-19 and pre-existing mental disorders; 3) to keep psychiatric services active by using all available options (for example telepsychiatry); 4) to increase communication and cooperation between different health care providers.

MEDICINE AND PSYCHOLOGY OF IBN SINA (AVICENNA) - A UNIQUE SCIENTIFIC AND RELIGIOUS APPROACH.

Ibn Sina (Avicenna) is primarily known for his philosophy and medicine, but there is almost no scientific discipline in which this great man didn't leave a significant mark. This paper gives a brief overview of his contribution to medicine and psychology through which his unique scientific and religious approach to the study of the phenomena of human being can be best seen. Medical works of Ibn Sina represent a pinnacle of most important medical achievements of his time. These works contain synthesis of all Greek, Indian and Iranian medical schools, but also new breakthroughs achieved by Muslim scholars through their own experimentation and practice. Although he wrote many medical works, his most important one is El-Kanun fit-tib, which can be translated as The Canon of Medicine. It's made out of five books which systematically show everything known in the area of medicine up until that point in time. In it, Ibn Sina discusses, among other things, the structure of psychological apparatus of human being and the connection of psychological functions with the brain. He considered psychology to be very important for medicine, so in his psychological works he discusses, in great detail, the essence of human soul, consciousness, intellect and other psychological functions. He observed a man in his entirety, taking into consideration all aspects of his existence, paying special attention to spiritual knowledge and spiritual perfection, religiosity, and methods of achieving inner peace and well-being.

Islamic Approach to the Psychotrauma: Animation, Growth and Transformation.

The paper gives an approximate significance of religion in the mental health of believers. Islamic views of the soul are presented, as a basic principle of human life. The correct, beneficial effects in the attitudes and behavior of individuals towards their souls are also shown. It is also shown what can negatively affect the soul, which creates a basis for the disruption of mental well-being, which causes a mental disorder or mental illness. The paper focused on Islam, as a complete worldview based on the theory of the Revelation of the Qur'an and the practices of God's Messenger, Muhammad, peace be upon him (p.b.u.h.) through which the Revelation was given to all mankind. The basic Islamic theoretical and practical principles and their beneficial protective and healing effect on the mental, psychosocial and psychosomatic well-being of the individual and the community are enumerated and briefly explained when the daily routine of Islamic living is properly applied. The paper presents the basic Islamic principles that help people who suffer sudden, short-term or long-term troubles and catastrophes, because of which psychological trauma and its acute and chronic consequences are formed, which makes the treatment of traumatized faster, and more efficient.

Islamic Approach to the Treatment of the Fear of Death.

Although the question of death and the fear of it is one of the oldest questions man has dealt with, we have no discussions from ancient times about fear in an existential sense. The thematic approach to this phenomenon in Western philosophy and theology occurs in Hellenism and in the Christian religion, but it gains its full meaning only in the philosophies of existence. The famous Islamic philosopher and physician Ibn Sina, better known in the West as Avicenna (980-1037), wrote A Treatise on the Cure for the Fear of Death and the Treatment of Anxiety Caused by It more than nine centuries ago. Relying on Islamic teachings, Ibn Sina made a comprehensive analysis of this problem in the Treatise, giving precise instructions on how to deal with people who have mental impediments due to the fear of death, which in modern psychiatry are called anxiety and fear-related disorders. In this paper, a brief analysis of the Treatise is made in order to point out possible guidelines in the approach to the problem of fear of death, which in modern psychiatry, psychopathology and psychotherapy is obviously not given enough attention.

A Treatise of the Islamic Philosopher Ibn Sina (Avicenna) on the Fear of Death and the Treatment of Anxiety Caused by It.

Although the issue of death and fear of it is one of the oldest issues that man has dealt with, modern secular psychiatry today, as before, does not pay enough attention to the phenomenon of fear of death. The famous Islamic philosopher and physician Ibn Sina, better known in the West as Avicenna (980-1037), wrote A Treatise on the Cure for the Fear of Death and the Treatment of Anxiety Caused by It, more than nine centuries ago. Bosnian Islamic scholar Mehmed Handzic translated this treatise from Arabic into Bosnian 80 years ago. This paper provides basic data and a summary of this translation with a focus on the analysis of key terms from the Arabic language used by the author in the original paper from the perspective of today's psychiatric terminology and then its integral translation into English. In addition to its historical significance, we believe that this discussion has its practical significance today, so we hope that this paper could encourage further fruitful discussions in professional circles dealing with this topic.

Meaning and the Sense of Meaning in Life from a Health Perspective.

A personalized and holistic approach to therapy is increasingly demanding answers to questions related to the meaning of life. Over the years, research has shown a direct link between the presence of meaning in life, health and recovery. It becomes impossible to ignore this connection as well as the issues of spirituality and religiosity that are immersed in the meaning of life. The article presents different definitions of meaning, the relationship of meaning in life and parts of meaning to quality of life, allostasis, stress, pathological conditions and recovery, and finally connecting the points between creative psychopharmacotherapy and meaning. A complementary approach to the meaning of life implies a desire for a clear, reliable understanding of three related but different dimensions: continuity (as opposed to fragmentation), purpose (as opposed to pointlessness), and value (as opposed to worthlessness). Creating personal meaning in life structures can provide a context for understanding and integrating stressful situations. Finding meaning means connecting, meaning are the expected connections and associations that human beings see in their world. In this aspect, the construction of meaning is a dimension that we impose on the world. Each person's ability is to decide what makes their life meaningful. The meaning of life is a changing cognitive-emotional framework, directly accessible to subjective assessment based on one's own needs and values. The art of living is to discover in though and painful life situations their true meaning, values and meaning of life, and thus health and disease. Creative psychopharmacotherapy can be used to help patients discover and explore the sensation of meaning, create a new meaning in life, a new life story, manifest their potential through recovery. Mental disorders present a chance to break with misplaced life goals and values and turn to authentic values through new forms of thinking, experiencing, behaving, and creating a successful life.

Mentalization and Change of Perception in the Context of Creative Psychopharmacotherapy Focused on People.

The concept of mentalization is relatively new in modern psychiatry, whose utilization is expanding daily in working with clients suffering from mental illness. Mentalization enables the incorporation of several different theoretical models and therapeutic techniques into a single whole, which encourages a holistic and integrative approach to treating patients. This theoretical model looks at different spheres of mental states, both the client seeking medical help and the doctor himself in the therapeutic process. Consequently, providing an adequate basis for the creation of a therapeutic/working alliance, which is imposed in the age of modern psychiatry, as a "condition without which it is impossible" to achieve the desired therapeutic response. Therefore, it is necessary to creatively implement treatments while creating a "therapeutic/working alliance" between the patient and the doctor in order to improve the therapeutic response and change the patient's perception.

The Significance of Understanding Body Language in Depressed Patients within the Context of Creative Psychopharmacotherapy.

Since it is generally known that the human body is the best image of the human soul, this paper aims to explain how important body language is when diagnosing psychiatric diagnosis "depression". It is important to point out the importance of other alternative approaches in the treatment of depression when standard psychopharmacotherapy is not enough. Body language is a powerful form of non-verbal communication that provides important traces of intentions, emotions, and motivations in other people. In everyday life, we collect information about what people think and feel by their body posture, manners, and gestures. Evaluations of clinical depression are traditionally based on verbal information. However, non-verbal expressive behavior, related to reflexive feedback of a person, may reveal negative emotional or social processes that are not fully controlled by patients therapy, along with other artistic therapies (art therapy, drama therapy, and music therapy are other artistic therapies that are applied in Great Britain) offers an attractive opportunity for patients because it enables them to work on those issues that are placed on non-verbal and pre-verbal level. Creative psychofarmacotherapy is the concept that involves creativity as its main means. In this context, the importance of physical activity and body movements will be emphasized in the treatment of depression, when regular psychopharmacotherapy is not sufficient. To conclude, the patient has the right to actively take part in creating a therapeutic relationship and responsibly contributes to overcoming psychopathology. The importance of physical activities and body movements is emphasized in the treatment of depressive people. Studies have shown that the anti-depressive effect of physical activity is increased with simultaneous use of antidepressants, as well as that movement therapy and music therapy, together with regular pharmacotherapeutic methods, help with fast recovery and that they can be used in a creative approach to problem-solving.

Emotional Contamination in the Context of Creative Psychopharmacotherapy.

It is well known that emotions have always attracted the special attention of both laymen and scientists because life without emotions is unthinkable. Emotions prepare us for all life circumstances regardless of their qualities and intensities. Reviewing the available literature, the authors described the phenomenon of emotional contamination and its importance in interpersonal relationships with a focus on "infecting" other people's emotions. Research has shown that individuals mimic facial expressions as well as other emotional reactions of others by emotional contamination in interaction with another person manifesting emotional behavior, and in such situations mimic model reactions, with the perception of their own reactions eliciting an appropriate emotional state. They stressed the importance of patient's perceptions of the emotions of the physicians treating them and the caring attitude that is crucial to contributing to treatment outcomes in clinical practice. Specific expectations between the patient and his physician, when they meet and achieve a physician-patient relationship, reduce uncertainty, and play a useful and crucial role in healing. A caring emotional practitioner who can effectively connect with patients is a huge boon to health. The connection of emotional contamination with creative psychopharmacotherapy and with several therapeutic options is especially described, determined in different ways either through narrative psychopharmacotherapy, through assertive and positive communication, creating a favorable and positive therapeutic relationship whereby a partnership is created, which together leads to the main goal, which is the successful treatment of the patient to the mutual satisfaction. It is useful for patients to have a doctor who spends more time with them and listens carefully and, with adequate emotions, strongly and effectively facilitates treatment. They conclude that emotional contamination is a phenomenon that happens every day in life, especially in specific situations, and that it is up to professionals to use this type of therapeutic opportunity and assistance in the right way to help their patients and be creative in a psychopharmacotherapeutic sense.

Acceptance of Diagnosis in Psychiatry and Influence on Treatment in the Light of Creative Psychopharmacotherapy.

In this paper, we focused on the complexity of diagnosis in psychiatry and problems during its communication, and its acceptance / non-acceptance, both by the patient and family members of the patient, which has a significant impact on the success of treatment. It is not uncommon for somatic diseases to be related to mental illness, which due to damage to certain organs requires adequate psychiatric therapy. The treatment process is a joint agreement between the patient, his / her family members and the psychiatrist regarding the explanation of the illness, how to take the medication and the agreement with the patient about the psychotherapy that would suit him / her best. Psychosocial support to the patient(s) is also very important in the treatment of psychiatric patients, because only with such support do we empower sick people, their families and the social environment, and the result is successful treatment and reintegration into everyday life in the community.

Creative Psychopharmacotherapy in Child and Adolescent Psychiatry and Experiences from Bosnia and Herzegovina.

INTRODUCTION: Paediatric psychopharmacology involves the application of psychotropic agents to the treatment of children and adolescents with mental disorders and gathered knowledge from child and adolescent psychiatry (CAP), neurology, paediatrics and pharmacology. Defining elements of this discipline are: the metabolism of drugs is different in children than in adults (pharmacokinetics), the developing brain reacts specifically to the drug (pharmaco dynamics), and psychopathology itself is not differentiated yet. To make and overview of specifics in psychopharmacological use in CAP and emphasize some experiences from Bosnia and Herzegovina in that field. METHODS: Through insight in current literature, we presented comprehensive findings and compare it with situation in Bosnia and Herzegovina. RESULTS: The most common conditions in which psycho pharmaceuticals are used in CAP were attention deficit hyperactivity disorders (ADHD), depressive and bipolar disorder, obsessive compulsive disorder and the treatment of early psychosis. Psycho pharmaceuticals were also used to treat agitated conditions in various causes. We made an overview of psycho pharmaceuticals use in Bosnia and Herzegovina CAP and emphasized the fact that psycho stimulants are not approved for the use yet, although they are mostly prescribed medicament in CAP over the world. That limits us in the effectiveness of the treatment in ADHD and put us in the situations to use other medicaments instead (anxiolytics, antipsychotics, mood stabilizers) which are not approved for that condition. CONCLUSION: The use of psycho pharmacotherapy in CAP is justified in cases where it is necessary to reduce the suffering of children and to improve their functionality at the time when cognitive, social and emotional advancement is most pronounced. Further research and clinical monitoring of efficacy and safety in the use of psycho pharmaceuticals in youngsters are necessary.

Creative Person-Centered Psychopharmacotherapy in the Context of Prenatal Psychiatry - Dilemmas and Challenges.

The authors presented a psychopharmacotherapeutic approach to the treatment of women in the prenatal period that requires a personalized, person-centered treatment plan. Treatment should include care for the mental health of women of childbearing age, pregnancy planning, during the prenatal period, and then during the postpartum period. The authors highlighted creative psychopharmacotherapy which is the foundation of holistic and integrative treatment of mental disorders. They emphasize the significant role of the mother in the emotional development of the child, which begins while the child is still in the womb. Mothers who stop taking psychotropic drugs during pregnancy have an increased risk of recurrence of the mental disorder after childbirth because the mother's psychiatric illness is not a benign event and can cause significant morbidity for both the mother and her child, therefore, discontinuation or denial of medication during pregnancy is not always the safest option. For more serious disorders, such as schizophrenia, bipolar disorder, and severe depression, medications may be needed during pregnancy and lactation, despite complex evidence based on the effects of psychotropic medications on the fetus and newborn. Perinatal mental health has become a significant focus of interest in recent years. The randomized controlled examinations provide evidence of the effectiveness of psychological and psychosocial interventions at the individual level. It is necessary to make a new conceptual shift in the approach to maintaining the mental health of pregnant women and newborns, and that is to optimize the mental health of pregnant women, and not simply reduce the symptoms of mental disorders from which they suffer before conception, during pregnancy and after childbirth. Dilemmas and challenges of psychopharmacotherapeutic treatment in the prenatal period are intensified by the knowledge that the psychological difficulties of mothers can significantly affect the integrity of the safe relationship between mother and child, which is essential for the emotional, cognitive, and behavioral development of the child. Often, these problems existed before pregnancy or occurred during pregnancy, and they are often the deterioration of the mental state due to discontinuation of pharmacotherapy during this period. The quality of the biopsychosocial milieu in the fetal period and childhood during the early neuroplastic development phase is one of the determinants of risk for diseases during the life cycle. For this reason, the mental health of pregnant women and mothers must be optimized. For many of these women, health is optimized with pharmacotherapy.

Gambling Disorder as an Addictive Disorder and Creative Psychopharmacotherapy.

Addiction does not mean "addiction to substances" only. At the core of the definition of substance dependence is the loss of control. Gambling addiction belongs to non-substance / non-chemical addictions or behavioral/behavioral addictions. The concept of behavioral addictions is new and revolutionary in psychiatry. Gambling addiction, formerly pathological or problematic gambling occurs due to loss of control over gambling. There is growing evidence to suggest that behavioral addictions resemble substance addictions in many domains, including phenomenology, tolerance, comorbidity, overlapping genetic contribution, neurobiological mechanisms, and response to treatment. Behavioral addiction has been proposed as a new class in the Diagnostic Statistical Manual Fifth Revision (DSM-5), but the only category included is gambling addiction. The prevalence of gambling disorders in adolescence is very high and for certain disorders (especially related to the use of the Internet) it becomes more pronounced over time. In this paper, we presented a comprehensive overview of gambling disorders from definition, epidemiology, manifestations, comorbidities, assessment, treatment options, and existing forms of treatment. Given the complexity of the approach to the treatment of gamblers, a creative individualized integrative approach is necessary, which is the basis of creative psychopharmacotherapy. Due to the possibility of the emergence of problem gambling and other impulse-control deficits we need to be very careful when commencing a patient on dopamine replacement therapy or therapy with aripiprazole.