BACKGROUND Schizophrenia (SCH) is a severe neuropsychiatric disorder associated with complex neurobiological alterations and suboptimal therapeutic outcomes. Increasing evidence indicates that mitochondrial dysfunction may contribute to SCH pathophysiology through impaired energy metabolism, oxidative stress, altered calcium homeostasis, and dysregulation of neuronal function. This review aims to summarize current knowledge regarding mitochondrial abnormalities in schizophrenia and to explore their potential involvement in the mechanisms of action of antipsychotic drugs. SUBJECTS AND METHODS A comprehensive review of the current literature was performed, focusing on human studies, cellular and animal models investigating mitochondrial alterations in schizophrenia, as well as studies evaluating the effects of antipsychotic medications on mitochondrial structure and function. RESULTS Available evidence demonstrates structural, molecular, and functional mitochondrial abnormalities in schizophrenia, including alterations in mitochondrial density, respiratory chain activity, oxidative phosphorylation, ATP production, and redox regulation. Antipsychotic drugs influence mitochondrial pathways in a complex and drug-specific manner. Some antipsychotics may impair mitochondrial respiration and increase oxidative stress, whereas others may exert compensatory or protective effects. Mitochondrial alterations may also contribute to cognitive impairment, negative symptoms, treatment response variability, and metabolic adverse effects associated with antipsychotic therapy. CONCLUSIONS Mitochondrial dysfunction represents an important component of schizophrenia pathophysiology and a potential therapeutic target. The interaction between mitochondrial pathways and antipsychotic drug effects highlights mitochondria as a possible pharmacodynamic interface for personalized treatment strategies. Further in vivo studies and biomarker-based approaches are required to clarify drug-mitochondria interactions and improve therapeutic outcomes in schizophrenia.

Insular cortex (i.e., insula; Latin for “island”), also known as the Island of Riel, represents a still poorly researched part of neural circuitry consisting of anterior and posterior areas divided by the insular central sulcus and surrounded by the peri-insular sulcus. Insula is involved in a variety of functions including gustatory and sensorimotor processing, somatic processing, as well as risk-reward behavior. Insula has been shown to play a major role in socio-emotional processes, such as emotional experience and introspection. Recent comprehensive meta-analysis studies suggest that lesion of the insular cortex can lead to significant psychiatric and neurological disorders as it plays a vital role in human motivation and emotional perception. Therefore, there is a growing interest in the medical community regarding this mostly unknown part of the human brain and the role of insular cortex in the pathogenesis of psychiatric disorders. Keywords: insula, neocortex, mental disorders.

Background: Schizophrenia is a complex and debilitating psychiatric disorder characterized by a constellation of clinical signs and symptoms that are categorized into distinct positive, negative, disorganization and cognitive symptom domains. It remains one of the most intriguing psychiatric research topics with a worldwide prevalence of 1% leading to lifelong disability in more than 50% of the sufferers. As a psychopathological entity, schizophrenia reflects the specific existential context of an individual, while maintaining a consistent core in regard to all stable and diagnostically relevant characteristics. In terms of content, schizophrenic manifestations display an abundance of individual differences, while the pattern related to symptoms and the course of the disease remains the same. No other disease can so radically damage the personality of the patient and potentially destroy the very foundations of what we consider to be the essential part of every human being. In medical terms, it is primarily a neurocognitive or neurobiological disorder. The outcome of the disease is better in female patients compared to male patients who have a higher risk of rehospitalization and twice as long duration of hospital treatment. An earlier onset of the disease in male patients, negative symptoms and a more severe clinical picture are noted, with a less promising therapeutic response to neuroleptics. The onset of negative symptoms is more variable. Objective: The aim of the study was to determine the correlation of positive and negative symptoms (PANSS scores) and quality of life (The Flanagan scale) in patients with schizophrenia according to gender. Methods: The sample included 40 subjects with schizophrenia (21 males; 19 females). The study was conducted at the Department of Psychiatry Clinical Center University of Sarajevo. Results: All male subjects have a PANSS negative symptoms score of 17 or higher, while all female subjects have a PANSS negative symptoms score of less than 17. While the difference in the variances is not statistically significant, the results show that the difference in the average values of the PANSS symptom score between male and female subjects is statistically significant for both positive and negative symptoms (p=0.026). The average score on the quality of life assessment scale for the observed group was 48.5 with a standard deviation of 5.6. The distribution of results on the Flanagan quality of life assessment scale (QOLS)deviates somewhat from the imaginary distribution of the normal distribution only in the area of higher and lower values, without the presence of distinct extremes. Negative symptoms were associated with different QOLS domains, but both positive symptom clusters showed no substantial association with QOLS. Conclusion: This aspect of the illness may account for the low level of emotional expression and neuromotor dysfunction in infants who subsequently have schizophrenia. In other patients, the negative symptoms first occur after the onset of psychosis. As a psychopathological entity, schizophrenia reflects the specific existential context of an individual, while maintaining a consistent core in regard to all stable and diagnostically relevant characteristics.

Background: Schizophrenia is chronic and debilitating psychiatric disorder, characterized by a constellation of clinical signs and symptoms that are categorized into distinct positive, negative, disorganization and cognitive symptom domains. The outcome of the disease is better in female patients compared to male patients who have a higher risk of rehospitalization and twice as long duration of hospital treatment. In male patients with schizophrenia an earlier onset of the disease, negative symptoms and a more severe clinical picture are noted, with a less promising therapeutic response to neuroleptics. The onset of negative symptoms is more variable. Objective: The aim of the study was to determine the correlation of positive and negative symptoms (PANSS scores) in patients with schizophrenia according to gender. Methods: The sample included 40 subjects with schizophrenia (21 males; 19 females). The study was conducted at the Department of Psychiatry Clinical Center University of Sarajevo. Results: All male subjects have a PANSS negative symptoms score of 17 or higher, while all female subjects have a PANSS negative symptoms score of less than 17. While the difference in the variances is not statistically significant, the results show that the difference in the average values of the PANSS symptom score between male and female subjects is statistically significant for both positive and negative symptoms (p=0.026). Conclusion: Diminished sociality, emotional responsiveness, and drive during childhood have been reported in a substantial minority of patients with schizophrenia. This aspect of the illness may account for the low level of emotional expression and neuromotor dysfunction in infants who subsequently have schizophrenia. In other patients, the negative symptoms first occur after the onset of psychosis.

Background: Cognitive dysfunctions are often presented as a symptom in multiple sclerosis which is associated with both structural and functional imapirments of neuronal networks in the brain. Objective: The aim of the study was to evaluate the influence of dysability, duration and type of disesase on cognitive functions in multiple sclerosis patients. Methods: This study included 60 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were clinically definite diagnosis of multiple sclerosis, 18 years of age or older and were able to give written informed consent. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCa) screening test. Mann-Whitney and Kruskal-Wallis test were used for comparisons between clinical characteristics and MoCa test scores. Results: Out of 63.33% of patients had EDSS <=4.5. Disease lasted longer than 10 years in 30% of patients. 80% had relapsing-remitting MS and 20% had secondary progressive MS. 84,2 % of patients with EDSS ≤ 4.5 had cognitive dysfunction. Higher disability (rho=0,306, p<0,05), progressive type of disease (rho=0,377, p< 0,01) and longer disease duration (rho=0,282, p<0,05) were associated with worse overall cognitive functions. Level of disability showed statistical significant correlation with the executive functions and language domains of cognition (p<0.01). Longer disease duration was significant correlated with executive functions (p<0,01) and language domains (p<0,01), while progressive type of disease was signifacant correlated only with executive functions domain (p<0,01). MoCa score variables did not show a statistically significant difference in relation to the number of relapses per year and the use of imunoterapy. Statistically significant negative correlation was obtained between executive functions domain and level of disability, disease duration and progressive type of disease, while language domain significantly correlated only with disability level and progressive type of disease. Conclusion: High percentage of MS patients has cognitive impairment. Patients with higher disability were presented with lower cognitive abilities, especially in executive functions and language domains. Higher frequency of cognitive impairment were presented in progessive forms of disaese and longer disease duration with strong influence on executive functions domains of cognition.

Background: Multiple sclerosis is a a complex diesase that may be presented by different neurological symptoms causing impairment of physical, psychological and cognitive functions. Objective: The aim of the study was to evaluate the influence of sociodemographic characteristics on cognitive functions in multiple sclerosis patients. Methods: This study included 60 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were clinically definite diagnosis of multiple sclerosis, 18 years of age or older and were able to give written informed consent. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCa) screening test. Mann-Whitney and Kruskal-Wallis test were used for comparisons between sociodemographic characteristics and MoCa test scores. Results: 76.66% were female patients. Average age of patients was 44.5 years. 70% of patients were married. 73,33% of patients had a high school degree, 20% had a college degree while only 6,66% had primary education. 38,33% of patients were employed, 33,33% were unemployed and 28,33% retired. 88.33% of patients had cognitive impairment, 68.33% having mild cognitive impairment. Executive functions (53,66%) and delayed recall (28,33%) were rated the worst. The median value of the Naming and Language MoCa domains of cognition showed statistical significant correlation with level of education (p<0.05; p<0.01).The mean value of the Language variable was statistically significantly lower in respondents aged 35 and over compared to respondents younger than 35 years (p=0,003;p<0,01), Statistically significant correlation was found between the level of education and cognitive status (rho=0,276,p<0,05), while the other variables (gender, age, marital status and employment ) did not show a statistically significant corellation. Conclusion: High perecentage of MS patients has cognitive impairment. Executive functions are rated the worst. Education is the major factor that contribute to better cognitive functioning in MS patients independent of age or employment status. The highest correlation is found between language and naming domains of cognition. Gender did not prove to be predictive factor of cognition in multiple sclerosis patients at any domain.

Background: Cognitive dysfunctions are considered as a poor prognostic factor that influence health-related quality of life in multiple sclerosis. Objective: The aim of the study was to evaluate the impact of cognitive impairment on the quality of life in multiple sclerosis patients. Methods: This study included 60 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were clinically definite diagnosis of multiple sclerosis, 18 years of age or older and were able to give written informed consent. Cognitivefunction was evaluated by the Montreal Cognitive Assessment (MoCa) screening test. Quality of life was evaluated by SF36 questionnaire. Results: 88.33% of patients had cognitive impairment with 68.33% with mild cognitive impairment. Abstraction (60,83%), language (56,66%), executive functions (53.66%) and delayed recall (28.33%) were rated the worst. The median value of SF-36 score was 54.1 (27.7-70.01). The lowest results were achieved in the QOL domains of psycial limitation with a median value of 12.5 (0-75) and emotional limitation 33.3 (0-100). It is found statistically significant correlation of the MoCa score with social functioning, energy, vitality and general health (p<0.05) and physical functioning (p<0.001) domains of quality of life, as well as with SF -36 total scores (p<0.05). Among group of patients with cognitive impairment, statistically significant positive correlation between cognitive status mental health HRQOL domain (rho=0.427; p<0.001) was found. Conclusion: Cognitive impairment is very often presented in patients with multiple sclerosis with significant contribution to a poorer quality of life. It is associated with physical and emotional limitations, as well as poorer mental health. Further studies are needed, especially when we take into account very important clinical and prognostic role of cognition in multiple sclerosis.

Background: The COVID-19 pandemic has generated significant symptoms of stress, anxiety, and depression among health care workers, which can negatively affect the health and well-being of individuals. Although the WHO stressed the importance of nurturing mental health in the context of the COVID-19 pandemic, a more significant response focused on this area was still lacking in most countries. Objective: The aim of the study was to examine the differences in the levels of depression, anxiety, and stress in healthcare professionals in relation to exposure to contact with COVID-19 positive patients, as well as to examine the differences and correlation of sociodemographic characteristics of health workers in the experience of symptoms of depression, anxiety and stress. Methods: The research included 266 respondents, and it used a socio-demographic questionnaire and the DASS-21 scale. Mann-Whitney U tests, Kruskal-Wallis test and Spearman correlation coefficient were used in data processing. Results: The prevalence of high to extremely high symptoms of depression was reported in 45.49% of employees, anxiety 63.91% and stress 23.22%. Those who have been in continuous contact with COVID-19 positive patients, or 27.07%, report experiencing high or extremely high symptoms of depression, 36.60%, high to extremely high symptoms of anxiety, and 22.18% high to extremely high symptoms of stress. Discussion: The degree of self-care and family care, education level, and work experience were found to be a statistically significant factor in experiencing symptoms of depression, anxiety, and stress. Workers who were more in contact with COVID19 patients reported a higher degree of symptom on the DASS-21 scale. Those employees with more work experience had previously encountered similar situations of uncertainty and pressure, had better developed defense mechanisms, and showed less pronounced symptoms. A higher level of education often implies a higher degree of involvement in active treatment around each patient, which results in more responsibility and pressure in a given situation. Conclusion: High levels of stress, anxiety and depression in healthcare workers can lead to repercussions in their work with patients. Therefore, the mental health of health workers should be put in focus, as a very important part of the public health problem during the COVID19 pandemic.