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: 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: 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: 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.

Background: The VEPs provide an objective measure of brain function, analyzing integrity of visual processing. With patients affected with schizophrenia, the changes with the implementation of VEP are evident, such as symmetrical deceleration of the impulse and the continuance of latency, which points to a degenerative illness, suggesting the presence of optical neuritis or hemianopsia conjoined with mentioned intracranial illness. Objective: The aim of the study was to determine the correlation of positive and negative symptoms (PANSS scores) and P100 latency between patients with schizophrenia and patients with migraine headache according to gender and age. Visual evoked potentials (VEPs) were applied. Methods: The sample included 80 subjects: a) S group- 40 patients with schizophrenia (21 males; 19 females); b) H group-40 healthy subjects with migraine headache (10 males; 30 females). The study was conducted at the Department of Psychiatry and Neurology University Clinical Center Sarajevo. Results: Our research revealed positive correlation of the P100 latency and the PANSS score of negative symptoms, which means that the subjects of the observed group with a higher latency of the P100 wave of the entire visual field in both eyes have higher PANSS scores of negative symptoms. The correlation is significantly higher in female subjects (37% shared variance) than in male subjects (12% shared variance). 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 positive correlations were registered in P100 latency in left view field of both eyes and in P100 amplitude in the region of right eye (p=0.01) in comparation with left eye region (p=0.05) in patients with schizophrenia. Conclusion: Results imply that the cognitive impairment seen in schizophrenia is not just due to deficits in higher order aspects of cognition but also encompasses significant deficits in early sensory processing. Our study is useful to initiate new questions and recommendations for further studies, specifically on changes in the occipital lobe in the schizophrenic patient’s brain.

Background: Multiple sclerosis is a progressive inflammatory disease of the the central nervous system. Problems with sexual functions are the common features of multiple sclerosis and important factor that contribute to the quality of life among affected persons. Objective: The aim of the study was to evaluate the influence of sociodemographic and clinical characteristics on sexual functions domains of health related quality of life (HRQOL) in multiple sclerosis patients. Methods: This study included 100 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were an Expanded Disability Status Scale score between 1.0 and 6.5, age between 18 and 65 years, stable disease on enrollment. HRQOL was evaluated by the Multiple Sclerosis Quality of Life-54 questionnaire. Mann-Whitney and Kruskal-Wallis test were used for comparisons between sociodemographic and clinical characteristics and HRQOL scores. Results: Out of 60% of patients reported to have sexual dysfunction, and 55 % were female patients. Younger patients had statistical significant higher median value of sexual function score (91.68 vs. 58,28, p=0.001) and satisfaction with sexual life scores (62.5 vs 37.5 , p =0.019) comparing to older patients. Employed patients also showed statistical significant higher median value of sexual function score (82 vs. 66.7, p=0.003) comparing to unemployed patients and also statisticaly significant higher median scores considering satisfaction with sexual life among employed patients (p=0,001). There were no differences in sexual functions scores considering gender, marital status and education. Patients with higher level of disabilty, progressive type of disease, more relapses and longer diseas duration had statistical significant lower median value of sexual function score and also satifaction with sexual life scores, except for disease duration Conclusion: Aging, dysability and progression are major factors that contribute to lower sexual function scores and satisfaction with sexual life among multiple sclerosis patients. Althoug women reported sexual problems more often then men, impact of these problems on quality of life are similar in men and women with MS.

Introduction Hyperprolactinemia is a common unwanted antipsychotic-induced adverse effect, particularly in female patients, and can induce poor adherence to treatment. Aripiprazole is an antipsychotic with partial agonist activity over the dopamine D2 receptors which can be effective in reducing hyperprolactinemia in patients treated with antipsychotics. Objectives We investigate the efficacy of adjunctive treatment with aripiprazole for olanzapine-induced hyperprolactinemia and related hormonal side effects (amenorrhea, oligomenorrhea) in female patients with schizophrenia. Methods Eight female patients (22 to 40 years old) participated in this study with a diagnosis of schizophrenia and hyperprolactinemia-related hormonal side effects (amenorrhea, oligomenorrhea). Patients were treated with aripiprazole 10 mg/day added to a fixed olanzapine dose of 20 mg/day. Serum prolactin levels were measured at baseline and after 2, 4, 6, and 8 weeks. Symptoms and side effects were assessed using the Brief Psychiatric Rating Scale, Clinical Global Impressions Severity scale, Barnes Akathisia Scale. Results Adjunctive treatment with aripiprazole resulted in significantly lower prolactin levels beginning at week 2. 87.5 % of patients at week 8 had prolactin levels normalize. Among 8 patients with menstrual disturbances, 75% of patients regained menstruation during the study. No significant changes were observed regarding psychopathology and adverse effect ratings. Conclusions Adjunctive aripiprazole treatment is effective for resolving olanzapine-induced hyperprolactinemia and reinstatement of menstruation in female patients, provides significant improvement and it appears to be safe with a lower risk of metabolic syndrome, without increased risk of adverse effects. Disclosure No significant relationships.

Introduction Schizophrenia (SCH) and bipolar affective disorder (BP) are complex disorders that overlapping both in their clinical symptoms and certain familiar characteristics. They share some common characteristcs but there are also key differences. The frequency of overlapping symptoms between these diseases could give us more information about the current validity of the diagnosis based on existing diagnostic criteria. Similarities within and between these two disorders in the future, can possibly redefine greater reliability of diagnosis. Objectives The aim of the study was to investigate the frequency of overlapping symptoms between BP and SCH. Methods The sample included 159 patients diagnosed with SCH and 61 with BP who were followed over a two year period. The research was conducted at the UCCS Psychiatric Clinic. Assessment of clinical symptoms and diagnosis were performed using a structured clinical interview (SCID I), a list of operationalized criteria (OPSCRIT), a scale for the assessment of positive and negative symptoms (PANSS), a scale for the assessment of manic symptoms (YMRS). Results The overall PANSS score was significantly higher in patients with SCH compared to patients with BP, but on the general psychopatology there are no significant differences betwen SCH and BP. Symptoms of mania are significantly more pronounced in patients with BP compared to those with SCH. Conclusions Our results of overlapping of individual symptoms between SCH and BP can speak infavor of the theory of disease continuum. And can also help us in understanding symptoms and guide us to develop optimal treatment strategies. Disclosure No significant relationships.

Introduction Clozapine is a drug that can cause several side effects. Among the less commonly described is a drug-induced lung disease. Due to its non-specific clinical presentation, it represents a diagnostic challenge. The diagnosis is made based on: 1. Association of exposure to the agent and development of symptoms, 2. Pulmonary infiltration, 3. Exclusion of other causes, 4. Withdrawal of symptoms when the agent is excluded from therapy. To date, there have been only a few descriptions of this condition. Objectives Case report of rare side effect of clozapine. Methods Case report Results Case report: male patient (37) with schizophrenia, was hospitalized after a brutal suicide attempt. The PCR test for COVID-19 that was routinely performed on admission was negative. After the introduction of clozapine into therapy, the patient became febrile. There was a drop in oxygen saturation, a Lung CT scan showed inflammatory changes („ground-glass opacities“), and COVID-19 pneumonia was suspected. Due to the worsening of the mental state, the dose of clozapine was increased. The physical condition further deteriorated: febrile, sO2 declining. After repeated PCR tests for COVID-19 (all negative), interstitial pneumonia caused by clozapine was suspected, and clozapine was excluded from therapy. The physical condition started to improve. Quetiapine was introduced, and occasional episodes of agitation were relieved with intramuscular diazepam. In the following days, the patient’s mental state improved and he was discharged. Conclusions Despite its superiority over other antipsychotics, clozapine was with good rationale ranked third in treatment guidelines for schizophrenia. Disclosure No significant relationships.