Epileptic psychoses - evaluation of clinical aspects.

Epileptic psychoses as the most complex psychopathological phenomena represent unexplored states for prognosis. Clinical trials, conveyed in order to found risk factors still are not consistent in their conclusions. By this research results of all biological, clinical, psychological and social, as well as demographic factors will contribute to opportunity to find variables which could finally prevent these conditions. In this study we tried to evaluate clinical variables which could foresee manifestation of interictal and postictal psychosis. This research study is epidemiological, clinical, retrospective and analytical. In total 567 patients were included in this study, which belonged to the diagnostic criteria F 0.6 according to ICD-10 classification, among which 14 patients with the diagnosed epileptic psychosis (06,8) were followed. All patients were hospitalized and evaluated at the Psychiatric Clinic in University of Sarajevo Clinics Centre, during time period between 01.01.2000 - 31.08.2006. Within baseline all relevant clinical and demographic variables were evaluated. Among patients most dominant form of behavior was expansive, with emphasized paranoid ideations and perception of auditory hallucinations. A correlation between intensive psychological trauma as an exacerbation factor and prolonged illness is determined, as well as between expression of psychotic symptoms and forced normalization by antiepileptic medications. Also is proven that among postictal psychosis more dominant are suicide attempts and aggressive behavior.

Morphologic differences of occipital region in patients with schizophrenia and migraine headache using magnetic resonance imaging (MRI) and visual evoked potentials (VEPs).

Aim To compare morphologic variations of occipital sulci patterns in patients with schizophrenia and migraine headache regarding gender and laterality using magnetic resonance imaging (MRI) and visual evoked potentials (VEPs) as well as damage of visual pathway in patients with schizophrenia. Methods This study included 80 patients. Brain scans and visual evoked potential responses recorded over the occipital cortex were performed to analyze the occipital region of both hemispheres. Average total volumes of both hemispheres and average values of latency of the healthy population were used for comparison. Results There was statistically significant difference between subjects considering gender (p=0.012). Parameters of body of the calcarine sulcus (p=0.0325) showed statistically significant positive correlation with P100 latency (p=0.0449), inferior sagittal sulcus (p=0.0443) had significant positive correlation with P100 latency (p=0,0413), lateral occipital sulcus (p=0.0411) and P100 latency (p=0.0321) showed statistically significant difference only of left hemisphere in male patients with schizophrenia with shallower depth of the sulcus and P100 latency prolongation. Conclusion The consistency of the findings reveals distinct multiple brain regions, which show changes in the gray matter of patients with chronic forms of schizophrenia. The neurocognitive deficits of schizophrenia show highly consistent cross-sectional relationships to each type of functional outcome.

Clinical features in emergency psychiatric conditions.

OBJECTIVES: An epidemiological, retrospective, and analytical study was conducted to evaluate frequencies of emergency conditions, gender, age and demographical differentials, thus highlighting all clinical and demographical parameters relating to suicide attempts. SUBJECTS AND METHODS: Two Hundred and Sixty Eight (268) patients hospitalized in the intensive care unit of the Department of Psychiatry at the Sarajevo University Medical Centre over the course of a one-year period (01.01.2004 - 31.12.2004) were examined and included in the study. Essentially, the symptoms were assessed via psychiatric examinations and through the medical history of the patients. The data collected by the study were analyzed statistically by using the SPSS and Chi Square test. RESULTS: 94% of all patients were hospitalized as being in an emergency situation, 6% were wrongly diagnosed and transferred into a relevant medical institution. 41% of patients were hospitalized at the point of crisis (with police and emergency medical staff), while the most frequent condition was exacerbation of schizophrenia (22.4%). Of the 94% of patients, 17.9% were suicide attempters, while the group at greatest risk was the youngest (18-24), although this group represents 4.5% of total. The other risk factors were male gender, age 30-49 years, single or divorced, and lower socioeconomic status. The most frequent means of attempted suicide was intoxication with medication. Nearly all the patients had made previous suicide attempts. DISCUSSION: The study was conducted to provide an important epidemiological information on the characteristics of emergency admissions to psychiatric units and to underline the problem of triage and monitoring for this type of patients. How to prevent crises remains an open question; however this and other studies provide the necessary data to assist in managing and resolving this issue in the future.

Obesity biological and psychological aspect.

There is no unique pattern to deal with obesity unless is presented as complex of biological and psychological factors. A lot of studies deal with only one side of it. This work shows both sides and discusses about all relevant factors, which are involved in pathogenesis of obesity. This is only way for finding better approaches for treatment and understandings for this issue.

Sertraline and alprazolam in the treatment of panic desorder.

A compared, 12 week, placebo controlled study, with fixed dose, outpatient study of patients diagnosed with panic disorder with and without agoraphobia according to ICD-10, was conducted to evaluate the efficacy and safety of sertraline and alprazolam. The study included 40 patients, divided in two groups. We evaluated number of ICD-10-defined panic attacks, agoraphobia and anticipatory anxiety. All patients were aged 18 year and older and were randomized to either sertraline or alprazolam. Sertraline applied in fixed doses of 20 mg/day and alprazolam in doses 1-1,5 mg/day significantly reduced the frequency of panic attacks in panic disorder patients, reduced symptoms of agoraphobia and anticipatory anxiety.

Models of treatment with antipsychotics of the schizophrenic patients.

The aim of this study were to determine which antipsychotic are currently in use, to establish which doses are administrated to patients, to find out is there a practice of proscribing simultaneously more then one antipsychotic drug, to determine whether antipsychotic are proscribed in divided doses, to establish whether there is, besides antipsychotics, treatment with other medicaments (co-administration), especially with antiparkinsonics. The research (study) is epidemiological-clinical prospective, descriptive and analytical and it was conducted at University hospitals in Sarajevo, Tuzla and Mostar. Criteria for inclusion, non-inclusion and exclusion from the study were precisely defined as a mean for formation of sample. Based on this hypothesis were established, zero and alterative. According to zero hypothesis in the treatment of schizophrenia at University hospitals in FBiH new antipsychotic drugs are in use, small doses are proscribed (up to 20 mg), not more then one antipsychotic drug is used simultaneously, antipsychotics are administrated once a day and alongside with antipsychotics other medicaments are not co-administrated, especially antiparkinsons. The results of our study are showing that majority of patients are treated with classical antipsychotics. Minority of patients is treated with atypical neuroleptics like olanzapine, which is proscribed only in Sarajevo. Use of risperidone and ziprasidone is registered also only in Sarajevo, but only small number of patients is treated with these drugs. Most frequent antipsychotics were promazine and haloperidol. The range between minimal and maximal daily dose of promazine was from 50 to 450 mg/daily, and for haloperidol from 1 to 75 mg/daily. Above-mentioned drugs were administrated in an average from two to three times a day. Alongside with antipsychotics, other drugs were used. Most frequent was the use of biperidine in oral and parenteral formulation, as well as nitrazepam and diazepam. The importance of this study is following: data are useful for the current mental health care reform in FBiH, results will point out place and position of FBiH in contemporary world trends in the treatment of schizophrenia, they will contribute to rational use of antipsychotic therapy, they will point out possible ways in reduction of side effects, often dangerous adverse effects of antipsychotics, and they will give contribution to faster rehabilitation of schizophrenics with the reduction of financial means for the treatment of patients with schizophrenia.

Mental health status can reflect disease activity in rheumatoid arthritis.

OBJECTIVE: A significant number of patients with rheumatoid arthritis (RA) link the start of illness with psychological trauma or severe stress. Impaired mental health (IMH), defined as depression and anxiety with psychoneuroimmunological factors, can play a significant role in RA. The main objective of this research was to investigate the mutual correlation of IMH and RA activity, estimated by the laboratory and clinical parameters in RA patients. MATERIAL AND METHODS: An open clinical prospective study that lasted for 6 months was designed. There were 72 patients included, 58 women and 14 men, aged 34 to 80 years and screened for mental health status. The study population was randomized following the Brief Symptoms Inventory (BSI) scale, comprised of 53 questions with a range from 0 (no symptoms) to 4 (severe). This mental test was done only once during the study. Following the results from the BSI scale, RA patients were divided into mentally stable and mentally unstable patients to investigate the influence of RA activity on mental health. The following laboratory and clinical parameters were analyzed: sex, age, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C-reactive protein (CRP), anti-cyclic citrullinated peptide (anti-CCP) antibody, and disease activity score (DAS28). All RA patients did not express extra-articular manifestations or Sjögren's syndrome. The chi-square test, ANOVA, Pearson's coefficient, and IBM Statistics - SPSS v19 were used. RESULTS: From a total of 72 RA patients, there were 44 mentally stable and 28 mentally unstable patients. All patients had either moderate or severe active disease. The only significant correlation of IMH and activity of RA was found in CRP and DAS28, but no significance was observed in ESR, RF, and anti-CCP. The DAS28 showed high disease activity with an average of 5.3 and CRP of 20.9 mg/L in patients with unstable mental health compared to stable mental health patients, where RA was associated with a moderate DAS average value of 4.35 and CRP of 14.1 mg/L. Depression and anxiety were found in all 28 (39%) RA patients. CONCLUSION: Mentally unstable RA patients correlate more with severe disease activity, while mentally stable patients express moderate disease activity.

Admission rate of patients with most common psychiatric disorders in relation to seasons and climatic factors during 2010/2011.

INTRODUCTION: Climate and its impact on human health and mental illness have been in the focus of the research since years in the field. AIM: The aim of the research is to study the admissions rate to the psychiatric clinic in correlation to seasons and climate. MATERIAL AND METHOD: The research was conducted in a Psychiatric clinic of the Clinical Center in Sarajevo. Randomly selected subjects (aged 5-89 years, 1316 males and 1039 females) N=2355, were interviewed by the Structural Clinical Interview (SCID) which generated DSM-IV. In this retrospective-prospective, clinicalepidemiological study subjects were divided into groups according to type of disorders. Correlation between the impact of seasons and the rate of admissions to a Psychiatric clinic was analyzed. Certain data were taken from Federal Hydrometeorological Institute in Sarajevo of the climatic situation for period of the study. RESULTS AND CONCLUSIONS: Of the total number of subjects who were admitted to the clinic in the period of 2010/2011 the most common diagnoses were F10-F19, F20-F29, F30-F39, F40-F48, and the suicide attempts as the separate entity. It was found correlation between certain seasons and the effects of the certain weather parameters at an increased admission rate of subjects with the certain diseases.

Prevalence of neurotic, somatoform and stress induced disorders in relation to the seasons and climatic factors during the 2010/2011.

INTRODUCTION: Psychiatric disorders have been considered to have seasonal variation for a long time. GOAL: The goal of this research is to study the admissions rate of neurotic and somatoform disorders, as well as stress induced disorder in relation to season and climatic factors during 2010/2011. MATERIAL AND METHOD: The research was conducted at the Psychiatric Clinic, Clinical Center of University in Sarajevo. Randomly selected subjects (aged 5-89 years, 1316 males and 1039 females) N=2355, were interviewed by the Structural Clinical Interview (SCID) which generated DSM-IV diagnoses. In this retrospective-prospective, clinical-epidemiological study subjects were divided into groups according to type of disorders. Correlation between the impact of seasons and the rate of admissions to a Psychiatric clinic was analyzed. Certain data were taken from Federal Hydrometeorological Institute in Sarajevo about the climatic situation for period of the study. RESULTS AND CONCLUSIONS: From the total number of subjects who were admitted to the clinic in the period of 2010/2011 the most common diagnoses were F10-F19, F20-F29, F30-F39, F40-F48, and the suicide attempts as the separate entity. It was found the correlation between certain seasons and the effects of the certain weather parameters at an increased admission rate of subjects with the neurotic, somatoform and stress induced disorders.

The frequency of depression and the comorbidity of psychotic disorders at day hospital of psychiatric clinic, clinical center of sarajevo university.

INTRODUCTION: Numerous epidemiological international studies as well as knowledge based on clinical experience show high prevalence and the importance of the psychiatric comorbidity with depressive and anxiety disorders. GOAL: The aim of this study is to analyze prevalence of comorbid anxiety disorders and depression in subjects at the Day Hospital of the Psychiatric Clinic, Clinical Center of Sarajevo University (CCUS) and examine the demographic profile of the patients. MATERIAL AND METHODS: Study involved 230 randomly selected patients (aged between 18 and 65 years, N=230, who were hospitalized at the Day Hospital of the Psychiatric Clinic of Clinical center of University of Sarajevo from January 1(st) to December 31(st) 2011) and who were interviewed by the Structural Clinical Interview (SCID) which generated ICD-X diagnoses and assessment of the comorbidity. Depressive symptoms were assessed by Beck's Depression Inventory with 28 items. Anxiety symptoms were assessed with Beck's Anxiety Inventory scale with 21 items. Study is retrospective, clinical and epidemiological. RESULTS: Of the total number of patients (230) it was determined that 107 (46.5%) have depressive episode; 71 (30.9%) anxiety disorder. Comorbidity of these two disorders was found in 14 (6.1%) cases. Anxiety disorders were more represented in women (61.2%), as well as depressive disorders and comorbidity (70.1% and 85.7%). Subjects with depression on average was 52.9±7.4 years old (range 29-64 years), patients with anxious disorders 50±9.5 years (range 22-65 years) while patients with comorbidity of these two entities was at mean age of 54.5±4.5 years. The least common category of education was retired persons and respondents with university education for all three entities. Hospitalization duration for depression, anxiety, and comorbidity of these two disorders is highest for depression (47.1±9.7 days) and shortest in case of comorbidity (45.9±6.9 days). CONCLUSION: Depression and anxiety often coexist. When they occur in comorbidity, both anxiety and depression appear to be more severe. Severely depressed and anxious patients have reduced capacity to work and as such represents a considerable burden to the family and the community. Overview of depression, anxiety and the comorbidity of these two diagnoses (listed as primary diagnosis) in the baseline sample showed that there was most patients with depression (107 or 46.5%), followed by anxiety (71 or 30.9%) and comorbidity with 14 patients or 6.1%. Effective assessment, evaluation, diagnosis and treatment can lead to better treatment outcomes in primary care and improved quality of life.

Correlation between moca and mmse for the assessment of cognition in schizophrenia.

INTRODUCTION: Schizophrenia (Sch) is a complex neurodevelopmental disorder associated with impairment of cognitive function as a central feature, which is confirmed by a number of studies performed on patients suffering from Sch, where clinical symptoms and social functioning of patients are consequences of neurocognitive deficits. GOAL: The goal of this study was to assess the clinical usability of the Montreal Cognitive Assessment (MoCA) as a screening instrument for cognitive impairment in schizophrenic patients, alone and in correlation with the Mini-Mental State Examination (MMSE). MATERIAL AND METHODS: This clinical prospective study included 30 patients diagnosed with schizophrenia. Patients were selected from Psychiatric Clinic, Clinical Center University of Sarajevo (CCUS) during 2010. For assessment of cognitive impairment we used Montreal Cognitive Assessment Scale (MoCA) and Mini-Mental State Examination (MMSE). RESULTS: From the total number of respondents (n=30), 15/30 (50 %) were males and 15/30 (50 %) were females; age of onset were 23.5±6.69; duration of illness before hospitalization (mean±SD) 32.5±12.9. If we make a comparison of MoCA scale and MMSE under the limit values, then we get that there was 10 true positive, 4 true negative, 14 false positive and 2 false negative. This all leads to sensitivity of MoCA scale again in comparison with the MMSE of 41.7%, specificity 66.7%, positive predictive value of 83.3% and negative predictive value of 22.2%. CONCLUSIONS: Our findings provide preliminary evidence that MoCA scale performs well in detecting true positive but it is imprecise in the detection of true negative findings.

[Parental attitude to psychoactive drug use in adolescents]. / Stavovi roditelja mladih koji konzumiraju psihoaktivne supstance.

Drug abuse is a problem worldwide, that destroys ones social, economical and family life. Our country is in a transition period and consist of postwar society. Therefore all risk factors for supstances abuse are present here such as social, economical, medical. Parental impact and peers seems to have strong impact on adolsecent with almost the same epidemiological characteristics in economical developed and undeveloped coutries. To find all risk factors is necessary for appropriate prevention approach. The aim of this investigation is finding some aspects of parenteral attitude related to drug abuse among early adolescents. Research covers 600 participants. Adolescents are equal gender and age distribution. It was used Q 2000 as research tool. Study design is prospective, epidemiological, analytica. Results showes that out of total number of adolescents (600) 15.55% were abusing alcohol, 6.69% smoke, 3.34% use cannabis. Parental impact and attitude which is presented in this study related to adolescent's drug abuse could be use as base for preventive activities.

[Analysis of the effect of the stress of war on schizophrenic psychosis]. / Analiza uticaja ratnog stresa na tok shizofrene psihoze.

Several experiments have shown an important relationship between schizophrenia and stress. People in Sarajevo and also, schizophrenic patients, who were in Sarajevo during the war, were exposed to frightful life experiences for over 1,300 days. The main goal of this investigation was evaluation of the course of schizophrenic psychosis in stress related war. Reason for this epidemiological study was a lack of knowledge about influence of war-stress on the course of schizophrenic psychosis, as well as, the fact that behavior of schizophrenic patients was changed during the war. This study was prospective, retrospective and controlled in its design. This influence of war related stress on the length and quality of remission of schizophrenic patients, the most common stress factors which impacted an schizophrenic patients during the war were identified, as wall as, different types and differences in demographic characteristics of patients who had different causes of schizophrenic psychosis. With this in mind, hypothesis between stress and course of schizophrenic psychosis were set. Experiment had covered those following groups: group (E), patients were hospitalized from 1.1.1987 to 31.12.1991, control group (K) patients were hospitalized from 1.1.1987 to 31.12.1991 but did not live in Sarajevo during the war and subsample of control group K (K1) which included schizophrenic patients who were hospitalized from 1.1.1987 to 31.12.1991, and were not treated in period from 6.4.1992 to 5.04.1995 despite the fact that they lived in Sarajevo during that period.

[Initial experience with human rights laws related to care of individuals with mental disorders]. / Prva iskustva primjene zakona o zastiti osoba sa dusevnim smetnjama.

This paper will review the patients in compulsory admission to treatment at the Intensive Care Unit of the Psychiatric Clinic in Sarajevo in the period from October 01 st, 2002 to October 01, 2003, following the adoption of the Law on Protection of Persons with Mental Disturbances. All the outstanding issues related to the enforcement of the law require caution and special attention and consultations with the incumbent Municipal courts responsible for the enforcement of the law.

Comparing youth health in Sweden and Bosnia.

The Adolescence Medical Group in Sweden has performed a questionnaire every second year since 1990. The questionnaire is performed during school hours in seventh and ninth grade and also in the second grade in the upper secondary school (gymnasium). The questionnaire is completed anonymously. The schools are not chosen by statistical methods, but more depending on youth-health-iterested school doctors and nurses who have interest in these studies. The result of these studies has been used locally in each community, but also been reported for example i Acta Pediatrica. After the war in Bosnia there has been different projects to help to build up the countries health system, for example in psychiatry. The question was laso raised how the youth health was in Bosnia. Representatives from the Adolescence section in Sweden were invited to Bosnia to introduce the questionnaire and also to help in analysing the results. We were also in Bosnia to present results to local authorities and those who performed the study locally.

Frequency of the antipsychotic therapy acute side effects in the treatment of acute psychosis.

Antipsychotic drugs produce a wide spectrum of physiological actions. Some of these effects differ among the various classes of antipsychotics. This medications have indications in the treatment of acute psychotic disorders. The main goal of this investigation was to determine the incidence and prevalence of the neuroleptic therapy acute side effects. The reason for this epidemiological investigation performing was the lack of knowledge of the exact neuroleptic therapy side effects incidence. Qualitative study on this problem has not been performed yet. Antipsychotic therapy side effects prevalence rate according to the literature data is ranging from 24% to 74%. Different prevalence rate is a consequence of different antipsychotic drug usage, different drug administration method and different side effects identification. On account of all these facts, we put the hypothesis on the correlation between the antipsychotic therapy and occurred side effects. Our experiment included all patients hospitalised from December 31st 1999 to January 31st 2000 in Intensive Care Unit of Biological Psychiatry Department of Psychiatric Clinic in Sarajevo. All patients were divided in three groups according to the applied therapy. All of them met ICD-10 criteria for schizophrenia (F20-29). During our study the following examinations were performed: psychiatric interview, BRPS, scale of side effects, psychophysiological tests, general clinical impression, scale of appetite, carbon hydrate needs scale. Psychiatric and statistical evaluations were done as well. The evaluation of our examination is showing successful results in all groups of patients. The improvement of psychopathological symptoms was insignificant. Reported side effects were minimal with low incidence rate and relatively high prevalence rate. Statistical tests were calculated from the obtained data after what the null hypothesis was rejected. Consequently, an alternative hypothesis was confirmed and it indicated that the acute side effects incidence and prevalence were within the range of expectation. Intensity of the recorded side effects was moderate to mild. On the basis of the obtained data, it has been concluded that applied antipsychotic agents did not induce more psychophysiological function impairments in the treated patients. Psychophysiological functions remained in physiological range limits and their changes were not significant. Neuroleptic therapy side effects were minimal, meaning no toxic signs or therapy discontinuations were recorded.