A. Sutović

2080 – A neuropsychiatric presentation of Wilson's disease - Case report

Introduction Wilsons disease (hepatolenticular degeneration), is an autosomal recessive hereditary disease of human copper metabolism, being characterised by excessive accumulation of copper in the body particularly the brain, liver, kidney and cornea. The diagnosis of Wilsons disease is easily overlooked. About half the people with Wilsons disease (40%), have neurological or liver symptoms. Psychiatric symptoms due to Wilsons disease are present in 15% of patients. Aim To present the case of an adolescent admitted to Clinic of Psychiatry, University Clinical Center Tuzla, initially presented with psychiatric and neurological symptoms, diagnosed at etiologic cause on the basis of biochemical abnormalities of a copper metabolisam, treated with etiological therapy and obtained therapeutic effect. Case report An 18 years old boy admitted to Department of Psychiatry, University Clinical Center Tuzla, with prior history of behavioral disturbances in the form of disinterest in the surroundings, decreased interactions with family and with signs of aphasia. Neurological examination revealed drooling of saliva, tongue protrusion and generalized cogwheel rigidity. Symptomatic treatment started with no therapeutic efficacy. After laboratory testings were done, findings showed low serum copper and ceruloplasmin levels, and with positive Kayser-Fleischer rings on ophtalmoscopic examination by slit lamp, and computerized tomography of the head indicate neuro-degenerative disease, Wilson disease has been diagnosed. After psychiatric observation and treatment started, patient was transferred to Department of Neurology, University Clinical Centre Tuzla. The patient responded very well to therapy with D - penicillamin, Clozapin, essential phospholipids, vitamins and pyridoxin. Regular follow up advised to evaluate the outcome.

Predictors of insight in patients with schizophrenia

Aim To establish predictors of insight in patients with schizophrenia with regard to symptoms severity, executive functioning, level of education, marital status, age, and number of hospitalizations. Subjects and methods A cross-sectional study was conducted on 60 consecutive outpatients with schizophrenia. Positive symptoms were established with 4-item Positive Symptom Ranking Scale (PSRS), and negative symptoms with Brief Negative Symptoms Assessment (BNSA). The level of insight was established with Self-Appraisal of Illness Questionnaire (SAIQ). Executive functions were established with Wisconsin card sorting test, and three verbal subtests from Wechlers Intelligence Test: information, similarities, and calculating. All neuropsychological tests were administered by psychologist educated in administration of these and other neuropsychological tools. Results Predictive statistical model identifies age and illness duration as negative, and higher level of education, and being married as a positive predictors of insight with 38.5% variance explained. Scores on subscales “Similarities” and “Calculating” had positive association with insight score. Model explains 24.7% of variance. When model was adjusted on alpha 5% level of concluding only three significant positive predictors appears: higher level of education, higher score on “Similarities” subscale, and being married. Model explains 38.5% of variance. Conclusion Level of education and marital status, among all other factors, have important impact on level of insight in patients with schizophrenia.

Opiate addiction recovery: New treatment with buprenorphine and naloxone (suboxone) helps bring families together in Bosnia and Herzegovina

Background The centre for medical prevention of opiate addiction established, as a part of the Tuzla University Clinical Centres Department of Psychiatry, is a result of several years of cooperation between the Tuzla department of psychiatry and the centre for addiction of the University Hospital in Orebro, Sweden. By working together, the scientists have developed the Tuzla model for opiate addiction in 2009, a first ever project of such kind in Bosnia and Herzegovina. Objectives To describe principles of organization and results of six years working period with buprenorphine+naloxone program. Method Authors described principles of organization and results of six years working period of the centre for medical prevention of opiate addiction in Tuzla. Results Once a patient is admitted to the center, a family member or a close friend signs a statement, committing to ensure that the patient will take the prescribed medicine regularly and always sticks around, from the very first psychiatric interview until the treatment finalization. This program helps create a bond between the addict and another person, which makes it different from other treatment programs which usually tend to isolate addicts in institutions. Another difference is that instead of methadone, patients receive another drug that has shown much better results–buprenorphine+naloxone (Suboxone ® ). Currently, the centre has about 160 patients who come for regular treatment and check-ups. Since the centre was established, over 260 patients were successfully treated. Conclusion The program helps families to rebuild their homes and relationships torn-apart by addictions, through rehabilitation, re-socialization and reintegration.

EPA-0908 – Successful treatment with interferon therapy of hepatitis c positive opiate addicts who are in substitution maintenance therapy with buprenorphine/naloxone (suboxone®)

Hepatitis C is highly infected disease with long period of failure to recognize it, what leads to chronic liver damage and lower chances for complete cure if detected late. Intravenous (IV) opiate users are not aware when be infected from virus carriers using the same non-sterile equipment so they pass the infection to other IV drug users. By implementation of substitution treatment of opiate addicts with Buprenorphine/Naloxone (Suboxone) at the Department of Psychiatry in Tuzla on 27 July 2009 year, we made the obligatory serological tests for hepatitis B and C and HIV, as well as laboratory findings with liver function parameter analysis as a condition for starting substitution therapy. In this way we discovered 50/195 opiate addicts hepatitis C positive. Although faced with danger of the final result if not treated in time, addicts when became aware that they were hepatitis C positive, they avoid further needed procedures leading to the inclusion of specific therapy with pegylated interferon. In this paper, the authors presented the procedure of multidisciplinary approach of treatment of hepatitis C positive opiate addicts despite their resistances they do not occur on the continuation of the procedure detecting HCV genotypes, and the inclusion of specific therapy for the treatment of hepatitis C in the clinics for infectious or internal diseases. At the end, the authors present eleven clinical vignettes of successful treatment of hepatitis C in opiate addicts realized with multidisciplinary team. All of the treated individuals, after finished interferon treatment appeared hepatitis C negative.

EPA-1059 – Metabolic syndrome in patients with schizophrenia: polypharmacy with first generation antipsychotics vs. clozapine alone

Background To establish the prevalence of metabolic syndrome and its parameters in group of patients with schizophrenia in polypharmacy – receiving first generation antipsychotics versus clozapine alone treated group. Subjects and methods 48 outpatients with schizophrenia divided into two groups: the first group of 21 patients in polypharmacy with first generation antipsychotics, and the second group of 27 patients treated with clozapine alone were assessed for the presence of metabolic syndrome. We used logistic regression models to assess the relationship between metabolic syndrome and antipsychotic therapy, gender and age. Results metabolic syndrome was found in 52.1% of all subjects. Compared to first generation antipsychotics polypharmacy, the monopharmacy with clozapine was associated with elevated rates of metabolic syndrome (28.6% vs. 70.4%, p= 0.004). With regard to particular parameters of metabolic syndrome, the elevated plasma triglycerides were significantly more present in subjects within Clozapine group (p=0.03). Logistic regression analysis showed that female gender (p= 0.004), older age (p=0.56), and clozapine treatment (p= 0.005) were significantly associated with metabolic syndrome. Discussion Results of this study are consistent with other studies, which showed that patients receiving Clozapine are at higher risk for metabolic abnormalities. Conclusion Compared to polypharmacy with first generation antipsychotics, the higher prevalence of metabolic syndrome is found in patients treated with Clozapine alone. The most prevalent metabolic disorder is dyslipidemia. Female gender, older age, clozapine treatment are significantly associated with metabolic syndrome.

1540 – Chronic multiple skin ulcers in an i.v. drug user (shooter's patch) disappeared after treatment with buprenorphine/naloxone (suboxone)

We present a case report of an individual with multiple chronic ulcers, which were cultivated and maintained for the administration of heroin. A 34 year old not married musician man lives with his widowed mother. His both parents finished secondary school. After father death they are living in very humble material conditions, below average financial monthly income. He was previously treated for heroin addiction in 2006 (five years ago), finished secondary school, not employed. Has no child. With 16 years he started with marijuana smoking. Nowadays he is IDU, and takes heroin every day, started with age of 18 years (16 years active heroin user). He started with IVU with 24 years (ten years ago). He used common accessories for intravenous heroin. He was HIV negative five days before he started maintenance substitution therapy of heroin dependency with buprenorohine/naloxone (Suboxone). The most modern medically assisted method of substitution treatment of opiate dependants with Buprenorphine/Naloxone (Suboxone) may improve quality of life (QoL) of treated opiate addicts and his/her skin damages caused with intravenous heroin misuse.

2018 – Problems in inducing interferon therapy of opiate addicts with hepatitis c who are in substitution maintainance therapy with buprenorphine/naloxone (suboxone)

Hepatitis C is highly infected disease with long period of failure to recognize it, what leads to chronic liver damage and lower chances for complete cure if detected late. Intravenous (IV) opiate users often pass the infection to other IV drug users, or themselves be infected from virus carriers using the same non-sterile equipment. By implementation of substitution treatment of opiate addicts with buprenorphine / naloxone (Suboxone) at the Department of Psychiatry in Tuzla on 27 July 2009. year, we made the obligatory serological tests for hepatitis B and C and HIV, as well as laboratory findings with liver function parameter analysis as a condition for starting substitution therapy. In this way we discovered 47/159 opiate addicts hepatitis C positive. Although faced with danger of the final result if not treated in time, addicts when become aware that they were hepatitis C positive, they avoid further needed procedures leading to the inclusion of specific therapy with pegylated interferon. In this paper, the authors present the problems that opiate addicts hepatitis C positive bring out as a reason they do not occur on the continuation of the procedure detecting HCV genotypes, and the inclusion of specific therapy for the treatment of hepatitis C in the clinics for infectious or internal diseases. At the end, the authors present efforts expert responsible for the treatment of hepatitis C in opiate addicts to organize a multidisciplinary team, in order to be coordinated Interferon therapy for each IV opiate addict positive for hepatitis C.

P01-47 - Medical assisted treatment of opioid dependence with suboxone method as prevention of social excluding young people

Introduction The most modern medically assisted method of substitution treatment of opiate dependants with Buprenorphine+Naloxone (Suboxone) has been implemented in Department of Psychiatry in Tuzla from 27 July 2009. Suboxone offers possibility for achievement of prompt and effective results of detoxification and weaning of opiates in outpatient treatment. Treated opiate dependants become “clear minded”, qualified for the all professional and social activities, what improves significantly quality of family and social relationship. With this, the treatment in the institutions can be avoided, therefore it prevents social excluding of treated individuals. Aim To present medical assisted treatment of opiate dependence with substitution medicament Suboxone in Bosnia and Herzegovina, with which we may prevent social excluding of young opiate dependants. Methodology With presentation of clinical vignettes, authors described how opiate dependants with social hazardous behavior avoided social excluding after they were included in the Suboxone maintenance treatment program. Results All exemplars described with clinical vignettes showed that opiate dependants previously had open doubts in efficacy of this particular treatment, and after only three days they surprised with positive effects of Suboxone. Also they are very satisfied with life quality during treatment. Family members of dependant person show satisfaction with achieved efficacy of Suboxone. Conclusion Medically assisted treatment of opiate dependence with Suboxone is implementing outpatient with involvement of close family members who are not drug dependant, it brings back “clear mind” to treated addicts, it does not stigmatize but it re-socialize and in that way it preventing social excluding of young opiate dependants.

P03-134 - Does the frequency of tobacco smoking in patients with schizophrenia varies with regard to the type of antipsychotic drugs?

Background Tobacco smoking is considered as one of leading preventable causes of death. High prevalence of tobacco smoking was reported among individuals with mental illnesses, and it is extremely high among patients with Schizophrenia. It is possible that antipsychotic drugs side effects are contributing to this negative trend. Objective of this paper was to establish frequency of cigarette smoking among patients with Schizophrenia hospitalized at the psychiatry clinic and to determinate the difference in frequencies of cigarette smoking among patients with Schizophrenia treated with first or second generation antipsychotics. Methods Study included 60 patients with Schizophrenia treated with antipsychotics for period of six months or longer. Experimental group included 30 patients treated with second generation antipsychotics, and control group included 30 patients treated with first generation antipsychotics. Descriptive statistical methods are used. The levels of statistical significance between parametric data were determined by t- test, and between nonparametric data by chi square test. Level of significance was established at P Results In this sample was 75% smokers, and out of this 46.6% consume up to 20 cigarettes per day, 40% consume 20 to 40 cigarettes, 8.8% between 40-60 cigarettes, and 4.4% consume over 60 cigarettes per day. There was no significant differences between groups of patients treated with first and second generation antipsychotics. Conclusion Tobacco smoking is very frequent among patients with Schizophrenia. In this study we did not found significant difference in frequency of tobacco smoking between groups of patients treated with first or second generation antipsychotics.

59 Hazardous lifestyles in patients with schizophrenia treated with antipsychotics: results of the Bosnian clinical study

detoxification of alcoholics. The alcohol history was assessed through a structured questionnaire. Reliable data on the history of medical disorders (liver diseases, pancreatitis, gastritis, gastric or duodenal ulcer, pneumonia, diabetes, hypertension, heart disease or brain trauma) were available for 43 patients. Results: Of the study 71.7% had current somatic problems or disorders. The most often are gastrointestinal disease pathology consisted of cardio-vascular diseases (stage II–III hypertension, ischemic heart disease, autonomic vascular dystonia), more cerebral degeneration, liver disease or alcoholic polyneuropathies. In our sample 36.7% are divorced; and 40% have heredity. Conclusions: Alcoholism is a major contributor to the physical ill-health. Treatment or rehabilitation of addictive behavior should be of major concern for adequate service planning or provision.