I. Pajević

Surviving genocide in Srebrenica during the early childhood and adolescent personality

Aim To examine how the experience of genocide in Srebrenica in the early childhood (ages 1-5) influences the psychological health in adolescence. Methods This study included 100 school-attending adolescents, age 15-16 (born in 1990-91) who were divided in two groups according to the place of residence from 1992-1995: the Srebrenica group – adolescents who lived in Srebrenica during the siege and the non-Srebrenica group who lived in the “free territory,” were not wounded, and experienced no losses. We used the socio-demographic questionnaire created for the purposes of our study and the War Trauma Questionnaire, Posttraumatic Stress Reactions Questionnaire, Self-report Depressive Scale (Zung), Freiburg Personality Inventory, and the Lifestyle Questionnaire. Results Srebrenica adolescents experienced significantly more traumatic experiences (14.26 ± 3.11 vs 4.86 ± 3.16, P < 0.001). Although there was no significant difference in the total score of posttraumatic stress reactions and intensity of depression between the two groups, significantly higher scores of posttraumatic stress reaction were noticed for several specific questions. The most prominent defense mechanisms in both groups were projection, intellectualization, and reactive formation. Srebrenica adolescents had higher sociability levels (34.7% vs 16.0%, χ2 = 7.231, P = 0.020). Conclusion Srebrenica adolescents reported significantly more severe PTSD symptoms and significantly greater sociability. Our findings could be used for planning treatment and improving communication and overcoming traumas in war-affected areas.

Psychological Problems Sequalae in Adolescents after Artificial Abortion

UNLABELLED STUDY AND OBJECTIVES: Controversy exists over psychological risks associated with unwanted pregnancy and consecutive abortion. The aim of this study was to assess the psychological health of female adolescents following artificial abortion up to 12(th) week of pregnancy. DESIGN The control case study. SETTING The study was carried out in the Department of Gynecology and Obstetrics, University Clinical Center Tuzla, in Bosnia-Herzegovina. PARTICIPANTS We assessed 120 female adolescents. The mean (SD) age of the patients was 17.7 (1.5) years experiencing sexual intercourse in the age of 14-19 years for trauma experiences, presence of posttraumatic stress symptoms, depression and anxiety as state, and anxiety as trait. Sixty adolescents had intentional artificial abortion and 60 had sexual intercourse but did not become pregnant. MAIN OUTCOME MEASURES We used the PTSD Questionnaire, the Beck Depression Inventory, and the Spielberger State Trait Anxiety Inventory (Form Y) for assessment of anxiety in adolescents. Basic socio-demographic data were also collected. RESULTS PTSD presented significantly more often in adolescents who aborted pregnancy (30%), than in adolescents who did not abort (13.3%) (odds ratio = 4.91 (95%CI 0.142-0.907) P = 0.03). Anxiety as state and as trait were significantly higher in the abortion group, as the mean (SD) anxiety score of patients was 59.8 (8.9), 57.9 (9.7) respectively, than in non-abortion group 49.5 (8.8), 47.3 (9.9) respectively (t = 6.392, P < 0.001; t = 5.914, P < 0.001, respectively). Adolescents who aborted pregnancy had significantly higher depression symptoms severity 29.2 (5.6) than controls 15.2 (3.3) (t = 8.322, P < 0.001), and they presented significantly more often depression (75%), than adolescents who did not abort (10%) (χ(2) = 53.279, P < 0.001). Logistic regression showed that only experience of life threatening(s) and injury of other person(s) reliably predicted PTSD, whereas abortion and experience of life threatening(s) reliably predicted depression. CONCLUSION Adolescents who aborted pregnancy presented significantly greater prevalence of PTSD and depression, and significantly greater depression severity and anxiety as state and trait than those who did not abort. Abortion predicted depression only, and did not predict PTSD.

P02-234 Spirituality and religiosity in the treatment of mentally disordered persons in Bosnia and Herzegovina

Spirituality and religiosity in the treatment of persons with mental disorders have a rich tradition in Bosnia and Herzegovina, but in the last half century these dimensions were unjustifiably ignored. Working with a large number of difficult traumatized people during the war, we perceived that religious people coped more successfully with a variety of difficulties that have afflicted them, than those who were not religious. Psychiatrists, who had the sensitivity to indicate the religious needs of certain clients in indicated cases, used the spirituality and religiosity in the process of healing. Following the trail of such remarks a number of empiric researches were done, which confirmed the justification for this approach. In that way the spirituality and religiosity found their place in the educational programmes for professionals in the field of mental health and psychotherapeutic treatment of psychiatric patients. Thereby, we as mental health providers, established cooperation with certain religious institutions and religious officials in that field, and we arranged in the framework of hospital institution adequate rooms for spiritual and religious needs of patients, which received their equal place with other necessary facilities.

Psychiatry in a battle zone.

The authors describe the arrival and treatment of 164 severe chronic psychiatric patients who were displaced from the Serbian army-controlled Jakes psychiatric hospital and off-loaded on the afternoon of 28th of May, 1992 at the gates of the Psychiatry Clinic in Tuzla. Through analysis of their incomplete medical records, which arrived with the patients in Tuzla, and analysis of their activities during and after the war, they found that 83 of the patients (50%) were males and 147 (89.6%) were admitted to the Psychiatry Clinic in Tuzla. Of the patients, 86 (58.5%) were found to be Serbs. The majority of them were incapable of independent living and required ongoing medical and social care. They were from all regions of Bosnia-Herzegovina, 81.6% had schizophrenia and 70 (47.6%) were over 50 years of age. For its humanitarian work, its contribution to peace and for the maintenance of the multi-ethnic Bosnia-Herzegovina, the Psychiatry Clinic in Tuzla received the Golden Award for Peace from the International Legion of Humanists in May 1998.

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.

The acculturation and repatriation problems and school behavioral problems reported from teachers among repatriated refugee adolescents in Bosnia-Herzegovina

Objectives: To describe the acculturation and repatriation problems and school behavior problems reported from teachers who were amidst Bosnia-Herzegovina (BH) repatriated school adolescents who were refugees after the 1992-1995 war, and to analyze possible differences between primary and secondary school students. Methods: The sample of 100 adolescents aged of 15.2 ± 2.4 years consisted from two groups: elementary and secondary school students (n=50, both equalized by gender), who survived the 1992-1995 war catastrophes, and were forced to spend certain refugee period in foreign country during and after this war. They were prevented to return to their original home places after repatriation because of no safety there. We used General questionnaire for personal information and trauma experiences, Personal questionnaire for acculturation and repatriation, and teacher’s version of the Children Behavior Check list, for (Achenbach CBCL). Results: Younger students reported lower adjustment and tendency to internalization. Older adolescents reported more intensive externalizing and other problems. Older adolescents reported significantly more often “thinking about his/her native place on arrival at the place of exile” and “thoughts about cousins”, while younger students reported more often “couldn’t play outside”. Teachers reported a number of behavioral disorders that returnees showed high maladjustment during repatriation. Returnees with greater acculturation problems showed increased functional and relational problems, however, with less psycho-emotional problems after repatriation. Conclusion: Younger students showed tendency to internalization and older adolescents showed significantly more intensive externalizing problems and other problems. Teachers have noticed a number of behavioral disorders that returnees showed as higher maladjustment during repatriation. Acculturation problems abroad were associated with functional and relational problems after returned at home. Correspondence to: Mevludin Hasanović, Department of Psychiatry, University Clinical Center Tuzla, Bosnia-Herzegovina, Tel: +387 35 267 111; E-mail: hameaz@bih.net.ba

Association of Islamic Prayer with Psychological Stability in Bosnian War Veterans

To compare the outcomes among war veterans who pray/do not pray and who were not suffering mental disorders after the Bosnia–Herzegovina war (1992–95). The sample consists of 100 healthy Bosnian war veterans divided in two equal groups—one, a highly religious group inside which were individuals who perform five obligatory prayers every day, and another group of individuals who do not practice any daily prayer. We used Minnesota Multiphase Personal Inventory (MMPI), Profile Index of Emotions (PIE) and Life Style Questionnaire (LSQ). War veterans who prayed had significantly higher levels for: incorporation, self-protection, and for reactive formation; but significantly lower levels for regression, compensation, transfer, no-controlling, oppositional and aggressiveness than their peers who did not pray. Practicing religion (regular performing daily prayers) is associated with reduction of tendencies towards the tendency for risk, impulsiveness, and aggression. It is also associated with successful overcoming of emotional conflicts in war veterans who practiced religion than their peers who did not practice religion.

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-0904 – Integrative complex personalized treatment of dual diagnoses of opiate drug addict person who is treated with maintenance substitution opiate therapy with buprenorphine/naloxone (suboxone)- case report

Opiate addiction is very often complicated with different clinical problems which are not visible because of complex clinical problems because of opiate dependency. We present a male drug addict aged of 31 year, married, he is a father of two kids, unemployed who has a complex history of trauma exposure during the war in Bosnia-Herzegovina. He survived several life threatened dangerous events with age of twelve. He started to misuse marijuana with 15 years; he started with heroin addiction with 20 years when he worked in Croatia. As intravenous drug user he became hepatitis C infected. He returned from Croatia and started to live in small village in Bosnia-Herzegovina in very difficult conditions. After induced in maintenance substitution opiate therapy with Buprenorphine/Naloxone (Suboxone), he appeared with symtoms of posttraumatic stress disorder (PTSD), he had seizures Grand mal, so we did complex clinical investigation. We found both side brain cortex reduction, and EEG positive finding. With Suboxone we introduced and Sodium-Valproate, SSRI and Clozapine because of heavy night mares. Despite complex psychopharmacotherapy his recovery was questionable. We introduced him in the Interferon treatment of Hepatitis C infection, but because of lack of money he quitted it after incomplete treatment three month after beginning. Because of increased chronic insomnia he was hospitalized for integrative complex personalized treatment. After working through of his trauma experiences in individual EMDR psychotherapy and after telling his severe trauma experiences in the group therapy of war veterans he recovered and dismissed to continue treatment as an outpatient.

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.