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.

Hazardous Lifestyles in Patients with Schizophrenia Treated with Antipsychotics: Results of the Bosnian Clinical Study

Background:

Individuals with schizophrenia are in greater risk of physical illnesses and their life is shorter comparing with general population. Hazardous lifestyles as tobacco smoking, lack of physical activity, and obesity contributing to this negative trend. Role of antipsychotic therapy, particularly second generation is also possible. This study aimed to establish hazardous lifestyles in clinical sample of patients with schizophrenia treated with first or second generation antipsychotics.

Method:

Study included 60 patients with schizophrenia (38.3% women) 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. Physical activity, tobacco smoking, and waist circumference as an increased body weight indicator were analysed. Overweight was defined as a waist circumference above 102 cm for males and 88 cm for females.

Results:

Mean age was 44.5±12.6. in this sample was 75% tobacco smokers, 30% of subjects taking typical, and 43% of subjects taking atypical antipsychotics declared physical inactivity during most of the day. Increased waist circumpherence was established in 51.6% of subjects. There wasn't statistically significant difference between two group of subjects (p=0.538).

Conclusion:

Hazardous lifestyles including cigarette smoking, lack of physical activity and increased body weight are common in the individuals with schizophrenia. There wasn't statistically significant difference between subjects taking first or second generation antipsychotics.

International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci

The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5-20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson's disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations.

Associations between Polymorphisms in the Solute Carrier Family 6 Member 3 and the Myelin Basic Protein Gene and Posttraumatic Stress Disorder

BACKGROUND

Previous research showed inconsistent results concerning a possible association between solute carrier family 6 member 3 (SLC6A3) gene polymorphisms and dopamine symptoms of posttraumatic stress disorder (PTSD). Several studies also indicate that the myelin basic protein (MBP) gene is of importance in the etiology of several psychiatric disorders. The aim of this study was to investigate the relation of distinct SLC6A3 and MBP gene polymorphisms with PTSD and whether SLC6A3 and MBP genotypes contribute to PTSD symptom severity.

SUBJECTS AND METHODS

The study included 719 individuals who had experienced war trauma in the South Eastern Europe (SEE). Genotypes of variable number tandem repeat (VNTR) polymorphism within the SLC6A3 gene were assessed in 696 participants, and the single nucleotide polymorphism (SNP) rs12458282 located within the MBP gene region was genotyped in a total of 703 subjects. The Mini International Neuropsychiatric Interview, the Clinical Administrated PTSD Scale (CAPS) and Brief Symptom Inventory (BSI), were used for data collection.

RESULTS

No significant differences concerning the investigated SLC6A3 and MBP polymorphisms was identifiable between PTSD and non PTSD participants. Also we could not detect significant influence of these distinct SLC6A3 and MBP alleles on the severity of PTSD symptoms (CAPS) or BSI scores. However, the results of MBP rs12458282 within the patients with lifetime PTSD may point to a possible correlation of the major allele (T) with elevated CAPS scores.

CONCLUSIONS

Our results do not support an association of the analysed SLC6A3 and MBP gene polymorphisms with PTSD in war traumatized individuals. We found that there is a possibility for a correlation of the T allele rs12458282 within the MBP gene with higher CAPS scores in lifetime PTSD patients which would need to be tested in a sample providing more statistical power.

The Role of TaqI DRD2 (rs1800497) and DRD4 VNTR Polymorphisms in Posttraumatic Stress Disorder (PTSD)

BACKGROUND

Posttraumatic stress disorder (PTSD) is a complex stress related disorder, that follows a severe traumatic experience, characterized with an intense sense of terror, fear, and helplessness. The aim of this study is to identify associations of genetic variations within candidate genes DRD2 and DRD4 with various PTSD related phenotypes. PTSD lifetime and PTSD current subjects were analyzed separately, each of them were analyzed in a Case/Control design, as well as regarding BSI and CAPS within cases only.

SUBJECTS AND METHODS

719 (487 male, 232 female) participants who had experienced war-related trauma between 1991 and 1999 in Bosnia and Hercegovina, Kosovo and Croatia were included in the study. Sociodemographic questionnaire, Clinician Administered PTSD Scale (CAPS) and the Brief Symptom Inventory (BSI) were used to collect clinical data.

RESULTS

The DRD2 rs1800497 variant and a variable number tandem repeat (VNTR) located in exon three of DRD4 were investigated for association with PTSD. In case control analyses we did not identify any significant associations. Within the PTSD current patients, we identified an association of DRD2 rs1800497 with BSI in the genotypic and the recessive model with the T allele as the risk allele.

CONCLUSION

Our findings suggest that rs1800497 of DRD2 gene is involved in pathogenesis of PTSD.

The organisation of mental health services in post-war Bosnia and Herzegovina

Bosnia and Herzegovina (BH) is located on the western part of the Balkan Peninsula. It has an area of 51 210 km2 and a population of 3 972 000. According to the Dayton Agreement of November 1995, which ended the 1992-95 war, BH comprises two ‘entities’ - the Federation of Bosnia and Herzegovina (FBH) and the Republic of Srpska (RS) - and the District of Brcko. The administrative arrangements for the management and financing of mental health services reflect this. The FBH, with 2 325 018 residents, is a federation of 10 cantons, which have equal rights and responsibilities. The RS has 1 487 785 residents and, in contrast, a centralised administration. Brcko District has just under 80 000 residents.

Monoamine Oxidase A Gene Methylation and Its Role in Posttraumatic Stress Disorder: First Evidence from the South Eastern Europe (SEE)-PTSD Study

BACKGROUND

Posttraumatic stress disorder is characterized by an overactive noradrenergic system conferring core posttraumatic stress disorder symptoms such as hyperarousal and reexperiencing. Monoamine oxidase A is one of the key enzymes mediating the turnover of noradrenaline. Here, DNA methylation of the monoamine oxidase A gene exonI/intronI region was investigated for the first time regarding its role in posttraumatic stress disorder risk and severity.

METHODS

Monoamine oxidase A methylation was analyzed via direct sequencing of sodium bisulfite-treated DNA extracted from blood cells in a total sample of N=652 (441 male) patients with current posttraumatic stress disorder, patients with remitted posttraumatic stress disorder, and healthy probands (comparison group) recruited at 5 centers in Bosnia-Herzegovina, Croatia, and the Republic of Kosovo. Posttraumatic stress disorder severity was measured by means of the Clinician-Administered Posttraumatic Stress Disorder Scale and its respective subscores representing distinct symptom clusters.

RESULTS

In the male, but not the female sample, patients with current posttraumatic stress disorder displayed hypermethylation of 3 CpGs (CpG3=43656362; CpG12=43656514; CpG13=43656553, GRCh38.p2 Assembly) as compared with remitted Posttraumatic Stress Disorder patients and healthy probands. Symptom severity (Clinician-Administered Posttraumatic Stress Disorder Scale scores) in male patients with current posttraumatic stress disorder significantly correlated with monoamine oxidase A methylation. This applied particularly to symptom clusters related to reexperiencing of trauma (cluster B) and hyperarousal (cluster D).

CONCLUSIONS

The present findings suggest monoamine oxidase A gene hypermethylation, potentially resulting in enhanced noradrenergic signalling, as a disease status and severity marker of current posttraumatic stress disorder in males. If replicated, monoamine oxidase A hypermethylation might serve as a surrogate marker of a hyperadrenergic subtype of posttraumatic stress disorder guiding personalized treatment decisions on the use of antiadrenergic agents.

Emotional Profile of Women Victims of Domestic Violence

INTRODUCTION

Research indicates that women victims of domestic violence show significant cognitive changes, emotional numbing, and avoidance of interpersonal relationships.

AIM

The aim of this research was to analyze emotional profile of women victims of domestic violence, and to determine the relationship between dimensions of emotions and frequency of women exposure to domestic violence.

METHODS

The research was conducted on the sample of 169 women, 111 were victims of domestic violence and 58 were women who did not experience domestic violence. Plutchik's Emotions Profile Index (EPI) was used for measuring of the emotion profile, and the Modified Inventory of Domestic Violence for measuring experiences of different types of violence. Basic socio-demographic data were also collected.

RESULTS

Significant differences between women victims of domestic violence and women who did not experience domestic violence were found in a few dimensions of emotional profile. Women victims of domestic violence had higher results in the dimensions of deprivation/depression and aggression/destruction, while women who did not experience domestic violence had higher results in dimensions of reproduction and incorporation. Aggression was in significant negative correlation with reproduction, incorporation and self protection, whereas it was significant positive correlation with deprivation and opposition. There were significant and positive correlation between the dimensions of aggression and deprivation and frequency of all three forms of domestic violence and age of women.

CONCLUSION

According to results obtained in this research, it can be concluded that women victims of domestic violence have significantly more intensive negative emotional dimensions in comparison to women who were not abused. Women victims of domestic violence with higher frequency of abuse describe themselves as more sad, apathetic, lonely, angry, quarrelsome and less sociable. Prominence of negative emotions, deprivation and aggression, can be factor of risk for mental health disorders and for re-victimisation of women victims of domestic violence.

Behavioral Problems and Emotional Difficulties at Children and Early Adolescents of the Veterans of War with Post-Traumatic Stress Disorder

INTRODUCTION

Behavioral problems and emotional difficulties at children of the veterans of war with post-traumatic stress disorder (PTSD) have not been researched entirely. In our country, which has a lot of persons suffering from some psychological traumas, this trauma seems to continue.

AIM

The aim of this study was to determine the exposure, manifestations of behavioral problems and emotional difficulties at children and early adolescents, whose fathers were the veterans of war demonstrating post-traumatic stress disorder symptoms.

RESPONDENTS AND METHODS

The analyzed group comprised 120 school age children (10-15 years of age), whose parents/fathers were the veterans of war. The children were divided into two groups, and each group into the following two age sub-groups: 10-12 (children) and 13-15 (early adolescents) according to PTSD presence at their fathers - veterans of war. PTSD symptoms at fathers, veterans of war, were assessed using the Harvard Trauma Questionnaire-Bosnia and Herzegovina version and MKB-10 - audit of criteria. To assess the behavioral problems of children, the Child Behavior Checklist for parents was used, and to evaluate the neuroticism at children Hanes-Scale of neuroticism-extraversion was used while the depression level was evaluated using the Depression self-rating scale (DSRS). To analyze the obtained results, SPSS 17 program was used. The value p <0. 05 is considered significant.

RESULTS

Children of fathers, the veterans of war, demonstrating the PTSD symptoms show more problems in activity, social and school conduct as well as in symptoms of behavioral problems compared to the children whose fathers do not demonstrate the PTSD symptoms (p<0. 001). Children of the war veterans demonstrating the symptoms of the post-traumatic stress disorder show significant difference at neuroticism sub-scales (p<0.001). Negative correlation between PTSD and activity, social and school conduct has been determined (p <0. 01), while positive correlation was determined between PTSD of war veterans with symptoms and neuroticism at children (p <0. 01). Depression symptoms are found at 17.5% children, while 28.3% are in the risky group and the girls demonstrate higher depression level.

CONCLUSION

Children and early adolescents of fathers - veterans of war with post-traumatic stress disorder show significant differences in competencies, behavior, emotional difficulties and neuroticism. Significant correlation was found between psychopathology of parents - fathers the veterans of war and their children. Impact of psychological conditions of fathers - the veterans of war with post-traumatic stress disorder to children is strong and they represent a significant risky group for development of mental disorders.

Molecular Mechanisms of Posttraumatic Stress Disorder (PTSD) as a Basis for Individualized and Personalized Therapy: Rationale, Design and Methods of the South Eastern Europe (SEE)-PTSD study

Posttraumatic Stress Disorder (PTSD) is a major health problem in South Eastern Europe (SEE). Available treatment options are not efficient enough and the course is often chronic. Little is known about molecular mediators and moderators of pathogenesis and therapy. Genetic and epigenetic variation may be one central molecular mechanism. We therefore established a consortium combining clinical expertise on PTSD from SEE countries Bosnia-Herzegovina (Sarajevo, Tuzla and Mostar), Kosovo (Prishtina) and Croatia (Zagreb) with genetic and epigenetic competence from Germany (Würzburg) in 2011 within the framework of the DAAD (Deutscher Akademischer Austauschdienst)-funded Stability Pact for South Eastern Europe. After obtaining ethical votes and performing rater trainings as well as training in DNA extraction from EDTA blood between 2011 and 2013, we recruited 747 individuals who had experienced war-related trauma in the SEE conflicts between 1991 and 1999. 236 participants had current PTSD, 161 lifetime PTSD and 350 did not have and never had PTSD. Demographic and clinical data are currently merged together with genetic and epigenetic data in a single database to allow for a comprehensive analysis of the role of genetic and epigenetic variation in the pathogenesis and therapy of PTSD. Analyses will be done to a great degree by PhD students from participating SEE centers who in addition to participation in the project had an opportunity to take part in spring and summer schools of the DFG (Deutsche Forschungsgemeinschaft) funded Research Training Group (RTG) 1253 and thus meet PhD students from Germany and other countries We are confident that our project will not only contribute to a better understanding of genetic and epigenetic mechanisms of PTSD as a basis for future individualized and personalized therapies, but also to the academic development of South Eastern Europe.

Metabolic syndrome in schizophrenia - who is more to blame: FGA polypharmacy or clozapine monotherapy?

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), and clozapine treatment (p=0.005) were significantly associated with metabolic syndrome.

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.

Psychosocial problems among children of parents with posttraumatic stress disorder

BACKGROUND

To assess the expression of psychosocial problems among children of parents with posttraumatic stress disorder (PTSD).

MATERIAL AND METHODS

A group of 100 children of school age (from 10 to 5 years old) from two randomly chosen schools has been analyzed. Children from complete families whose parents accepted psychometric measurement related to trauma have been chosen. Subjects were divided into two groups: a group of children whose parents express the symptoms of posttraumatic stress disorder (PTSD)-experimental group (N = 50) and group of children whose parents are not suffering from PTSD-control group (N = 50). The assessment of PTSD symptoms and parental traumatisation is done by Harvard Trauma Questionnaire-version for Bosnia and Herzegovina (B&H) (Allden et al., 1998), behavioral problems were assessed by Child Behavior Checklist--as reported by parents (CBCL, Achenbach, 1991), the level of traumatisation and posttraumatic symptoms in children by the Impact of Event Scale (Horowitz, Wilner, Alvarez, 1979), and neurotism and extraversion is estimated by Neurotism and Extraversion Scale (HANES). With regard to gender and parental participation the sample is homogenous. Data are processed by descriptive statistics method.

RESULTS

Children whose parents are suffering from PTSD symptoms show statistically significant increase in behavioral problems such as withdrawal, somatic complaints, thought problems, delinquent and aggressive behavior (p < 0.001), anxiety/depression, attention deficit and problems in social relations (p < 0.005). Male subjects showed more prominent delinquent behavior (p < 0.01). Children whose parents have PTSD symptoms show significantly expressed internalisation (p < 0.001) and higher level of stress (Chi2 = 23.528, p < 0.001), compared to children of parents without PTSD. There is statistically significant difference regarding the mean (M) of symptom groups among the analyzed groups of subjects related to the symptoms of intrusion (p < 0.01) and symptoms of avoidance (p < 0.001). Significantly expressed neurotism is present in children of parents with PTSD (p < 0.001).

CONCLUSION

The results show that children of parents with PTSD express a significant behavioral problems, higher level of neurotism, internalisations, posttraumatic stress reactions, symptoms of intrusion and avoidance as well as significantly higher level of stress compared to children of parents without PTSD.

Relationship between anger, alcoholism and symptoms of posttraumatic stress disorders in war veterans

PURPOSE

Studies among veterans indicate that veterans with posttraumatic stress disorder (PTSD) express anger, hostility and aggression as well as alcohol and substance abuse more then veterans without PTSD. The aim of this study was to analyze the relationship between anger, use of alcohol and symptoms of PTSD in war veterans in Bosnia and Herzegovina (B&H).

METHOD

Comparing a group of veterans (n = 54) with PTSD who use alcohol and a group of veterans (n = 46) who do not use alcohol, the analyzed were dimensions of anger related to PTSD symptoms and alcohol usage. Medical records of patients treated at the Department for Psychiatry in Tuzla, B&H, Harvard Trauma Questionnaire (HTQ)--version for Bosnia and Herzegovina, State-Trait Anger Expression Inventory (STAXI), Structured Clinical Diagnostic Interview (SCID-I) were used in this study. The basic socio-demographic data were also collected.

RESULTS

A significant correlation is found between alcohol usage, and state and trait of anger (P < 0.001), angry temperament (P = 0.001), anger-in expression (P < 0.001), anger-out expression (P < 0.001), and anger control (P < 0.001). PTSD hyperarousal cluster symptoms were significantly correlated to state anger, anger-in expression (P < 0.05), and use of alcohol (P = 0.010).

CONCLUSION

The results indicate that there is a significant correlation between PTSD arousal symptom with anger dimensions, as well as between anger dimensions and use of alcohol in war veterans with PTSD.

Somatic diseases in patients with posttraumatic stress disorder

PURPOSE

Numerous studies indicate that the exposure to traumatic events and psychological trauma is a widespread. Studies also show the frequency of comorbidity of mental disorders in patients with posttraumatic stress disorders (PTSD), while the effects of exposure to traumatic events on somatic health have been neglected for a long time. As PTSD might have a devastating effect on physical integrity and general health, the aim of this study was to show the prevalence of somatic problems in patients with PTSD.

METHOD

Analyzed were 217 patients treated in the period from 2005 to 2008 at the Traumatic Stress Disorders Unit of the Department for Psychiatry Tuzla, in which PTSD was diagnosed using DSM IV criteria. The medical records, Harvard Trauma Questionnaire (HTQ) - version for Bosnia and Herzegovina for identification of war traumatic events and PTSD symptoms, modified Domestic Violence Inventory, general questionnaire on socio-demographic data and data related to psychosocial issues were used in this study. Somatic diseases were diagnosed by ICD-10.

RESULTS

The average age of patients was 48.0246.33 years, with somewhat higher prevalence of male patients (136 ys 81). The highest number have completed secondary school (73.3%), were married (88%), employed (61.3%) and, of domicile status (83.4%). Out of 217 patients, in 85.7% the PTSD was related to war traumatic experiences. Somatic complaints and diagnosed chronic somatic diseases were present in 184 or 84.8% patients of both sexes. The highest number of patients had a hypertension, angina pectoris, back pain and degenerative bone diseases, as well as cerebrovascular disease and diabetes. More than three chronic somatic diseases were present in 85 or 39.2% patients with PTSD, and most frequent psycho-social problems were insufficient financial resources and a job loss.

CONCLUSION

Based on the results of this study it can be concluded that association of somatic diseases with posttraumatic stress disorder is often present in persons who were exposed to multiple war traumatic experiences and more psychosocial problems.

The organisation of mental health services in post-war Bosnia and Herzegovina

Bosnia and Herzegovina (BH) is located on the western part of the Balkan Peninsula. It has an area of 51 210 km² and a population of 3 972 000. According to the Dayton Agreement of November 1995, which ended the 1992-95 war, BH comprises two 'entities' - the Federation of Bosnia and Herzegovina (FBH) and the Republic of Srpska (RS) - and the District of Brcko. The administrative arrangements for the management and financing of mental health services reflect this. The FBH, with 2 325 018 residents, is a federation of 10 cantons, which have equal rights and responsibilities. The RS has 1 487 785 residents and, in contrast, a centralised administration. Brcko District has just under 80 000 residents.

Contact network and satisfaction with contacts in children whose parents have post traumatic stress disorder

AIM

The aim was to analyse contacts network and satisfaction with contacts among children of parents with post traumatic stress disorder (PTSD).

SUBJECT AND METHODS

The sample consisted of 100 pupils (age 10 to 15) from two randomly chosen schools. Children were selected from general population, lived with both parents who have had war traumatic experiences. They agreed to participate in psychometric research. We divided them in two groups: observed (0) group of children (N=50) whose parents were showing symptoms of post traumatic stress disorder (PTSD) and control (C) group of children (N=50) whose parents did not show symptoms of PTSD (evaluated by Harvard trauma questionnaire-BiH version). Contact network was examined by a Map of Contact Network which includes contact and satisfaction with persons in close environment. In relation to gender representatives of fathers and mothers, sample was homogenous.

RESULTS

The most important persons in children whose parents are showing symptoms of PTSD were schoolmates (88.0%), home mate (86.0%), mother (72.0%), and father (2.0%). At children whose parents did not show symptoms of PTSD, most important persons were schoolmate (94.0%), mother (80.0%), brother (6.0%), grandfather (8.0%), and father (14.0%). The most distinct disappointment in contacts in children with parents with PTSD symptoms were family, relatives and friends, in school and formal contacts (p < 0.001).

CONCLUSION

Children of parents who have had symptoms of post traumatic stress disorder (PTSD), the most important persons that they communicate were schoolmates and they had problem in communicating with fathers and males. According to satisfaction children whose parents suffered from PTSD were showing distinction in contacts with their families, relatives, schoolmates and formal contacts.