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Assess possible differences in quality of life assessment between the group of veterans who meet the criteria for the diagnosis of chronic PTSD and the group of veterans who do not meet the criteria for the diagnosis of chronic PTSD. Compare and analyze possible differences between the two groups in socio-demographic characteristics.
Subjects and methods
The subjects were 100 adult men, veterans with combat exposure who met the inclusion criteria for the study and agreed to sign the informed consent. The subjects were divided in two groups, each comprising of 50 subjects. Experimental group consisted of 50 veterans with combat exposure who meet the criteria for the diagnosis of chronic PTSD according to ICD-10. Control group consisted of 50 veterans with combat exposure who do not meet the criteria for the diagnosis of chronic PTSD. The subjects were assessed with the following standardized psychometric instruments: MMSE, MINI, IES-90 R, MANSA; Life Stressor List and a socio-demographic questionnaire:
The subjects with PTSD assessed satisfaction with all components of the quality of life significantly lower than the subjects from the non-PTSD group. Yet, the scores assessing the satisfaction with family life, although lower than in the non-PTSD group, were relatively high in the PTSD group (4,76 ± 1,3).
The results indicate the importance of factors of both PTSD diagnosis and the posttraumatic environment on the subjective perception of the quality of life for the subjects in this study.
Olanzapine is a novel antipsychotic agent. It has a pleotrophic pharmacology and affects dopaminergic, serotonergic, muscarinic and adrenergic activities. The therapeutic advantage of recent antipsychotics (so-called atypical antipsychotics) has been attributed to alpha-2 adrenergic antagonist effects.
The aim of this study was to evaluated effectiveness of Olanzapine in patients with schizophrenia.
Study was designed for 8-week, observational study. 40 patients, both genders, aged 20-65 years, with diagnosed various types of schizophrenia were enrolled in the study as outpatient and inpatient setting. The patients had to have a total score ≥40 on Positive and Negative scale - two parts of the Positive and Negative Syndrome Scale (PANSS). The efficacy parameter was the percent of score difference between baseline and week 8 of therapy on two above-mentioned PANSS subscales. The difference was considered as significant improvement if decrease from the baseline was 20% or more.
All 40 enrolled patients completed the study. After the 8 weeks of treatment, 32/40 patients (80%) had clinically significant improvement of 20% or more decreased total PANSS score (Positive and Negative subscale). In 8/40 patients (20%) clinical improvement was also reported with < 20% decreased total PANSS score.
In this observational study olanzapine appears to be very good effectiveness in patients with schizophrenia.
There is a growing evidence that oxidative injury contributes to the patophysiology of schizophrenia (Sch), where higher concentrations of nitric oxide (NO) found to be neurotoxic. Data also suggest that bilirubin (BR) can serve as an endogenous scavenger of NO. The aim of this pilot study was to compare the serum levels of BR and NO among patients suffering from Sch, as well as to estimate whether NO serum levels differ between patients and healthy controls.
The study population were consisted of inpatients (n=20) who met DSM-IV diagnostic criteria for Sch confirmed by Structured Clinical Interview (SCID 1) and healthy controls (n=20). In order to exclude psychiatric morbidity in control subjects the same diagnostic procedure was applied. Serum BR levels were measured by the method of Ehrlich. NO concentration in serum was determined by classic colorimetric Griess reaction
In patients with schizophrenia BR serum level were 9.85±1.182 mmol/L ; X±SEM. Serum NO level was significantly higher in patients with Sch (23, 26 ± 1, 76 μmol/L; X±SEM) than in control subjects (14, 36±1, 42 μmol/L; X±SEM, p=0.001). Correlation between serum nitric oxide and BR values were 0.1518.
Results of this study reveal that BR plays possible protective role in NO cell toxic activity. Our finding of increased serum NO levels in patients with Sch indicates its potential role in pathophysiology of this severe psychiatric disorder. However, those results are preliminary and have to be confirmed in sample of larger size.
Interictal depression as a co-morbid disorder can be seen among more than 40% of patients with epilepsy. Sex, epilepsy duration, type of seizures as well as applied antiepileptic drugs can cause development of depression which influence patient's life quality.
To test relation between depressive disorders and patients sex, duration of illness, type of epileptic fits, antiepileptic therapy and life quality.
Material and methods:
Prospectively, randomly selected, we tested 300 patients with epilepsy, with or without depressive affective disorder at the Outpatient Department for Epilepsies at the Clinical Center Sarajevo. All patients answered Beck and Hamilton depression scale.
Baseline is consisded of male patients which made 54 % with the average age of 37.7 years, as well as female patients at average age 32.83 years. Depressive disorder according to the results at the Beck scale was present in 34%, and according to the Hamilton scale in 38.9%. Duration of illnesses longer than 20 years had 56% women with the expressed depressive disorder, compared to the 42% men's with depression (p< 0.01). Partial complex seizures were more often among women (p< 0.05). Carbamazepin as monotherapy was applied for more than a half of the baseline, and combined with carbamazepin significantly more frequently among men's (p< 0.0001), while female patients had significantly more often Lamotrigil.
Depressive disorder is significantly more frequent among women with partial complex seizures, earlier epilepsy onset, and significantly more often on Phenobarbital therapy. Presence of depression with epilepsy significantly reduced patient's life quality.
Evaluation of psychoeducation effects on professional stress consequences within prison guards.
In the research were included 122 prison guards from three prisons in Bosnia and Herzegovina. All of them have been tested before and after psychoeducation was finished using following instruments: Index of reaction, STAI questionnaire, SAMAČA questionnaire.
Differences between first and second measuring of subjects included in this study in Sarajevo prison indicated statistically significant reduction of stress reactions, improvement of coping strategies and communication skills. In prisons in Zenica and Kula there are differences between first and second measurement in stress reactions reduction, improvement of coping strategies and overcoming of stress and improvement of communication skills as well, which are not statistically significant. In Kula Prison, significant differences between two measurements in attitudes of prison guards toward detainees were observed.
Results of this study show that prison guards within prisons where are detained persons with long period of imprisonment (Zenica, Kula) are more exposed to professional stress, comparing to prison guards who are employed in investigation prison (Sarajevo). Psychoeducation resulted in positive effects and it should be obligatory included in prison guards training with the aim of decreasing of psychological consequences of prolonged professional stress to which they are exposed to. Psychoeducation should be on continuous basis and led by educated mental health professionals.
To assess possible differences in plasma cholesterol, triglycerides, LDL-C, HDL-C, VLDLC, Index of arteriosclerosis and Established risk factor for arteriosclerosis and 10 year risk of coronary disease between veterans with combat experience with PTSD and veterans with combat experience without PTSD. To compare and analyze differences between groups in socio-demographic characteristics, trauma exposure, coping strategies and quality of life.
Plasma lipid parameters were determined and risk factors calculated for 50 subjects in the PTSD group and 50 subjects in the non-PTSD group. Groups were homogenized in gender, age, BMI, smoking status and somatic or psychiatric co-morbid disorders or the use of medications influencing blood lipid levels. Trauma exposure, coping strategies and quality of life were assessed with referenced psychometric instruments, socio-demographic characteristics with use of questionnaire.
Subjects in the PTSD group had significantly higher levels of all plasma lipid parameters except for HDL-C that was significantly lower. Risk factors were significantly higher in PTSD group. There was no significant difference in indices of exposure to combat trauma. Secondary traumatization was significantly more frequent in PTSD group. There were significant differences in socio-economic parameters, quality of life assessment and repertoire of coping strategies.
The results of this study provide further evidence for the onnection of chronic PTSD and blood lipids abnormalities and cardiovascular risk factors. The results indicate the importance of posttraumatic environment factors and coping strategies for the occurrence and persistence of PTSD.
Aim of this research is to assess the level of posttraumatic growth within war torture survivors.
Research sample consisted of 128 clients who experienced war torture and who are included in multidisciplinary rehabilitation in The Center for torture victims in Sarajevo. As research instruments Sociodemographic questionnaire (CTV Sarajevo, 2006), List of stressful events (Butolo,Foa,Riggs-PSS 3) and Posttraumatic Growth Inventory (Tedeschi and Calhoun,1996) were used.
Sociodemografic data in this study shows that average age of the sample is 56, and that 55% male examinees were included in the study. Most of them were Bosniaks, and 53,1% unemployed. The results on the List of stressful events shows that 96,9% of clients experienced physical assault by unknown person and 92,2% of them experienced ethnic cleansing. The results on total PTGI in this research shows the mean value (2,2909) which indicates that they experienced moderate change after traumatic event. The highest score (2,9531) is related to subscale of Higher appreciation of life, while the lowest score (1,7578) is obtained at the subscale of New possibilities.
The results of this research shows that after being exposed to extreme traumatic events like war torture, even fifteen years after that, the level of posttraumatic growth within war torture survivors in Bosnia and Herzegovina is moderate.
By the and of the war in Bosnia and Herzegovina process of psychiatric care reform has started by implementation of community mental health care concept. This way of mental health care organization is based on community mental health centres.
Aim of this article is to assess the level of patients satisfaction with community mental health care provided within community mental health centers.
Research was conducted in three towns (Sarajevo, Zenica and Banja Luka) in Bosnia and Herzegovina in which the best possibilities for implementation of new organizational concept of care are existing. As research instrument adapted version of Patient satisfaction questionnaire within outpatient community mental health care was applied randomly with community mental health centers users.
In all targeted areas users of care expressed with high score their satisfaction with mental health professionals understanding for their situation and high level of trust toward mental health professionals. They were satisfied with time they spent with person who treat them, as well as with frequency of contacts with them, efficiency of therapy and efficiency of treatment in general. The level of satisfaction with the information regarding the treatment was optimal, but the lowest score for these items were registered in town Zenica.
Results of the study, according to the level of patients satisfaction with services provided within community mental health centers, as a measure of their quality, indicates that focused community mental health centers provide services of good quality. It is neccessary to improve patients information regarding mental health disorder they are suffering from, as well as about treatment possibilities.
The most common psychical disorder which occurs with epilepsy is interictal epilepsy which life prevalence is 40%-60%.
To establish the frequency of depressive disorder in epileptic patients taking into account socio-demographic characteristics and the type of epileptic seizures.
Material and Methods
The survey comprised randomly chosen 476 patients treated at the Dispensary for epilepsy at the Neurology Clinic, University Clinical Center Sarajevo. All patients were tested with MMSE, Beck and Hamilton depression tests.
In the surveyed sample males were represented with 53.4%, mean age 36.7 years and SD=12.58, while mean age in females was 33.3% and SD=12.58%. 80% of patients had high school education. Male patients had significantly higher rate of marriage and employment than women (p<0.001). Two thirds of patients had partial seizures with or without secondary generalization. Out of that number women had significantly more frequent seizures with partial complex symptoms. Depressive disorder was present in 34% of patients at the Beck scale and 38.8% at the Hamilton scale, significantly more frequent in women.
Depressive disorder was significantly more present in middle-aged women, predominantly in women with high school education, unmarried, unemployed, with significantly more frequent seizures with partial complex symptoms than males.
Today we have a large number of articles that investigate oxidative stress and potential role of nitric oxide (NO) in the pathophysiology of schizophrenia and a lot of evidence of altered antioxidant capacity. Interesting scientifically facts is that bilirubin acts as an endogenous scavenger of NO, giving him the role of antioxidant that is reduced in schizophrenia.
Antioxidant properties of bilirubin through its interaction with the nitric propose that bilirubin-nitric oxide as a new biomarker of oxidative / nitrosative stress.
The aim of our study was to investigate possible correlation between serum levels of nitric oxide and bilirubin in patient's whit schizophrenia.
The study was consisted of 50 patients with schizophrenia and 50 healthy controls. We investigated the levels of nitric oxide, which is determined by conversion of nitrate to nitrite and then measuring with Greiss reagent, but only in group patients we measured the mean levels of bilirubin, within of course of illness.
Mean of NO between group patients and controls are statistically significant (CI = 13.31–27.29, t = 5.863, p = 0.0001). The average value of total bilirubin in patients suffering from schizophrenia was presented with SD = 11.77; 6.06 ± 0.86, and is statistically significant differences between the flow of diseases with the level of bilirubin, where the highest values detected markedly with the first hospitalization.
Antioxidant capacity of schizophrenia decreases with the progress of the disease. We can deduce that imbalanced between NO and bilirubin participates in the pathogenesis basis of schizophrenia.
Postpartum depression is a non-psychotic depressive episode occurring in postpartum period or continuing from pregnancy. Prevalence of PPD is about 12% in general population. The most dangerous consequences of PPD are mother’s suicide and infanticide.
Assess symptoms of PPD in the first month after delivery at regular home visits to new mothers using Edinburgh Postnatal Depression Scale (EPDS) and symptoms of acute stress reaction using Impact of Events Scale revised (IES-R). Determine correlation between EPDS and IES-R scores. Determine risk factors for PPD comparing results of EPDS scale and socio-demographic questionnaire.
Study included 50 women, ages between 21 and 42 who gave birth less than a month prior to assessment. Instruments used for this study were: EPDS, IES-R and socio-demographic questionnaire specifically designed for this study.
16% of women had EPDS scores indicating possible PPD, 16% had clinically insignificant symptoms, while 4% had clinically significant symptoms of postpartum PTSD. A significant correlation between EPDS and IES-R score was determined. These variables showed statistically significant influence on EPDS score:, age of mother at first pregnancy, education, work status, smoking during pregnancy and Caesarean section. All women who had EPDS indicating possible PPD had 3 or more risk factor for PPD.
The results indicate considerable presence of PPD in women in Sarajevo Canton, and the need for screening for PPD and timely interventions that can prevent possible complications some of which can be serious.
Quality of life reflects comprehensive personal satisfaction with life. It represents subjective experience of individuals, which undoubtedly depends on objective circumstances of life. There are several studies dealing with quality of life within student population. Such studies provide important information considering the fact that students reprsnt the healthy part of the population.
The goal of this study was to register and compare parameters of subjective perception of QOL in medical students and students of humanities.
Study involved 200 students of Sarajevo University, 100 medical and 100 students of humanities. MANSA questionnaire was used to assess QOL.
Statistically significant differences between the groups was found in repeated years of study, quality of teaching and professor-student relationship, sex life, finances and psychological wellbeing. No significant difference was found in satisfaction with life in general, number and quality of friendships, leisure time, accommodation, family relationships, health, and tobacco and PAS use. There was no difference in general assessment of QOL between the groups. Also both groups of students were satisfied with their current QOL.
Although no significant differences were found between groups, results reflect less satisfaction with quality of teaching and repeated study years in medical students. Clearly, study of medicine is a long and difficult process, and it should be a common goal for all involved in educating future physicians to contribute, in order to create professional and competent doctors, able to take care of quality of their own lives and the lives of their patients
Depressive symptoms in schizophrenia are important not only because they contribute significantly to the suffering caused by the illness but also because they exacerbate deficits in psycho social functioning and commonly precede attempted and completed suicide.
It is important to define and clinically assess such symptoms accurately as there is now increasing evidence that they can be treated successfully.
The authors assessed the presence and severity of depressive symptoms, as well as their associations with other clinical and socio-demographic measures, in a group of patients with schizophrenia, who were not in a major depressive episode or diagnosed with schizoaffective disorder. And also possible differences in frequency of depressive symptoms in inpatient and outpatient group.
Thirty adult inpatients with schizophrenia and 30 comparison subject with schizophrenia in outpatient treatment were studied. Depressive symptoms were rated primarily with the Hamilton Depression Rating Scale. M.I.N.I. Screen and M.I.N.I were used to screen out other disorders and confirm the diagnosis of schizophrenia. Socio-demographic questionnaire that was used was designed specifically for this study.
Our results indicate significant presence of depressive symptoms in all study subjects. Mean value of total HAM-D score for the whole sample was 15,63±7,724, corresponding to mild depression. Average total score was significantly higher in the subgroup of inpatients (18.97±6,636) compared with (12,3±7,373) in outpatients.
The results indicate significant presence of depressive symptoms in patients diagnosed with schizophrenia. This should probably be reflected in guidelines for evaluation and treatment of these patients.
Depressive episodes are common in bipolar illness. Treatment of bipolar depression is often problematic because standard antidepressants carry a number of disadvantages: apparent lower efficacy than in unipolar depression; risk of inducing mania; risk of inducing rapid cycling. Anticonvulsants such as carbamazepine, valproate and lamotrigine are useful in the management of bipolar disorder and they can prevent episodes of depression. There is less evidence that they have antidepressant efficacy but lamotrigine was shown to produce antidepressant effects in a placebo-controlled trial in bipolar depressed patients. Lamotrigine has a role in acute management of bipolar depression and is probably free of a risk of inducing mania or rapid cycling.
To determine the efficacy of lamotrigine in treatment of patients with bipolar depression.
Investigation of lamotrigine efficacy with bipolar depression in 3 month-follow-up and 6 months follow-up treatment with lamotrigine.
The sample consisted of 30 patients with bipolar depression, age range between 26 and 58. All subjects received monotherapy with lamotrigine in the period of six months. Subjects were assessed prior to therapy and in 3 and 6 months follow-up using the following instruments: The Clinical Global Impressions scale (CGI), and Hamilton Depression Rating Scale (HAM-D-21).
The difference between three assessments on CGI was statistically significant. The results indicate statistically significant reduction of depression on HAMD-21 following six months treatment with lamotrigine.
Lamotrigine proved to be efficient in the treatment of patients with bipolar depression for the subjects in this study.
The aim was to assess whether experiences of war trauma remain directly associated with suicidality in war affected communities when other risk factors are considered.
Materials and methods
In the main sample 3313 participants from former Yugoslavia who experienced war trauma were recruited using a random sampling in five Balkan countries. In the second sample 854 refugees from former Yugoslavia recruited through registers and networking in three Western European countries. Sociodemographic and data on trauma exposure, psychiatric diagnoses and level of suicidality were assessed.
In the main sample 113 participants (3.4%) had high suicidality, which was associated with number of potentially traumatic war experiences (odds ratio 1.1) and war related imprisonment (odds ratio 3) once all measured risk factors were considered. These associations were confirmed in the refugee sample with a higher suicidality rate (10.2%).
Discussion and conclusions
Number of potentially traumatic war experiences, in particular imprisonment, may be considered as a relevant risk factor for suicidality in people affected by war.
Depression is common in patients suffering from somatic diseases particularly chronic, life threatening and disabling diseases such as renal impairment requiring hemodyalisis. It contributes to further deterioration of the quality of life. The goal of consultation psychiatry is to advise screening and early interventions for this most often treatable disorder.
To assess and compare presence and severity of depression, and subjective assessment of QOL between patients on hemodialysis and healthy subjects.
This study included 80 subjects age between 19 and 82 (× 49.6 ± 14.2) on continuous hemodyalis and 40 subjects from the general population of Zenica. Assessment instruments used: Beck Depression Inventory – BDI; SF36- QOL, and sociodemographic questionnaire.
The subjects in the experimental group had significantly higher (p<0.05) average score on BDI, 17.1 ± 9.4, corresponding to mild to moderate depression compared with the subjects in control group who scored an average of 8.5 ± 7.0 (range 2-39), which corresponds to absence of depression. Comparison of results on a scale for assessing the quality of life SF 36, indicates that the subjects in the control had a higher average score or higher quality of life compared to the experimental group.
The research results indicate a significant difference in the presence of depressive symptoms and in the subjective assessment of QOL in patients on hemodialysis compared to healthy subjects. This justifies routine screening for depression in this group of patients.
Prevalence rates of post-traumatic stress disorder (PTSD) following the experience of war have been shown to be high. However, little is known about the course of the disorder in people who remained in the area of conflict and in refugees.
We studied a representative sample of 522 adults with war-related PTSD in five Balkan countries and 215 compatriot refugees in three Western European countries. They were assessed on average 8 years after the war and reinterviewed 1 year later. We established change in PTSD symptoms, measured on the Impact of Events Scale – Revised (IES-R), and factors associated with more or less favourable outcomes.
During the 1-year period, symptoms decreased substantially in both Balkan residents and in refugees. The differences were significant for IES-R total scores and for the three subscales of intrusions, avoidance and hyperarousal. In multivariable regressions adjusting for the level of baseline symptoms, co-morbidity with depression predicted less favourable symptom change in Balkan residents. More pre-war traumatic events and the use of mental health services within the follow-up period were associated with less improvement in refugees.
Several years after the war, people with PTSD reported significant symptom improvement that might indicate a fluctuating course over time. Co-morbid depression may have to be targeted in the treatment of people who remained in the post-conflict regions whereas the use of mental health services seems to be linked to the persistence of symptoms among refugees.
Prevalence rates of mental disorders are frequently increased in long-settled war refugees. However, substantial variation in prevalence rates across studies and countries remain unexplained.
To test whether the same sociodemographic characteristics, war experiences and post-migration stressors are associated with mental disorders in similar refugee groups resettled in different countries.
Mental disorders were assessed in war-affected refugees from the former Yugoslavia in Germany, Italy and the UK. Sociodemographic, war-related and post-migration characteristics were tested for their association with different disorders.
A total of 854 war refugees were assessed (≥255 per country). Prevalence rates of mental disorders varied substantially across countries. A lower level of education, more traumatic experiences during and after the war, more migration-related stress, a temporary residence permit and not feeling accepted were independently associated with higher rates of mood and anxiety disorders. Mood disorders were also associated with older age, female gender and being unemployed, and anxiety disorders with the absence of combat experience. Higher rates of post-traumatic stress disorder (PTSD) were associated with older age, a lower level of education, more traumatic experiences during and after the war, absence of combat experience, more migration-related stress, and a temporary residence permit. Only younger age, male gender and not living with a partner were associated with substance use disorders. The associations did not differ significantly across the countries. War-related factors explained more variance in rates of PTSD, and post-migration factors in the rates of mood, anxiety and substance use disorder.
Sociodemographic characteristics, war experiences and post-migration stressors are independently associated with mental disorders in long-settled war refugees. The risk factors vary for different disorders, but are consistent across host countries for the same disorders.
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