OBJECTIVE A significant number of patients with rheumatoid arthritis (RA) link the start of illness with psychological trauma or severe stress. Impaired mental health (IMH), defined as depression and anxiety with psychoneuroimmunological factors, can play a significant role in RA. The main objective of this research was to investigate the mutual correlation of IMH and RA activity, estimated by the laboratory and clinical parameters in RA patients. MATERIAL AND METHODS An open clinical prospective study that lasted for 6 months was designed. There were 72 patients included, 58 women and 14 men, aged 34 to 80 years and screened for mental health status. The study population was randomized following the Brief Symptoms Inventory (BSI) scale, comprised of 53 questions with a range from 0 (no symptoms) to 4 (severe). This mental test was done only once during the study. Following the results from the BSI scale, RA patients were divided into mentally stable and mentally unstable patients to investigate the influence of RA activity on mental health. The following laboratory and clinical parameters were analyzed: sex, age, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C-reactive protein (CRP), anti-cyclic citrullinated peptide (anti-CCP) antibody, and disease activity score (DAS28). All RA patients did not express extra-articular manifestations or Sjögren's syndrome. The chi-square test, ANOVA, Pearson's coefficient, and IBM Statistics - SPSS v19 were used. RESULTS From a total of 72 RA patients, there were 44 mentally stable and 28 mentally unstable patients. All patients had either moderate or severe active disease. The only significant correlation of IMH and activity of RA was found in CRP and DAS28, but no significance was observed in ESR, RF, and anti-CCP. The DAS28 showed high disease activity with an average of 5.3 and CRP of 20.9 mg/L in patients with unstable mental health compared to stable mental health patients, where RA was associated with a moderate DAS average value of 4.35 and CRP of 14.1 mg/L. Depression and anxiety were found in all 28 (39%) RA patients. CONCLUSION Mentally unstable RA patients correlate more with severe disease activity, while mentally stable patients express moderate disease activity.

Introduction: The role of hyperhomocysteinemia in psychotic disorder can be explained by partial antagonism of homocysteine on NMDA-glycine receptor. Plasma concentration of homocysteine is an indicator of the status of the B-vitamins (folate, B12, B6). Folate defi ciency may have different effects on the neurochemical processes of schizophrenia. This suggests that the association between elevated levels of homocysteine and schizophrenia is biologically very likely. Methods: The study was consisted of 20 patients with schizophrenia and 20 healthy controls. We investigated the levels of serum homocysteine concentration using AxSYM (Abbott), levels of folate assay is two-step immunoassay to determine the presence folate in human serum using CMIA (chemiluminescent microparticle immunoassay) technology and Axsym Holo Tc is microparticle enzyme immunoassay (MEIA) for the quantitative determination of human holo TC in serum and determination defi cit of vitamin B 12. Results: The patients group has higher levels of homocysteine in compare with controls group for 3.85 μmol/L while the concentration of folate in the group of patients was lower for 9.17 ng/mL. The mean level of vitamin B-12 in investigation groups were in reference range 19.1-119 pmol/L, but patient group have lower average concentration of vitamin B-12 lower for 24.81 pmol/L compared to the control group. Conclusion: Our results showed that homocysteine concentration is inversely proportionate to folate concentration, i.e. as homocysteine concentration in serum increases, folate concentration falls. Shizophrenic patients with elevated tHcy level and low folate levels should have vitamin supplementation with folic acid.

Introduction: Schizophrenia (Sch) is a complex neurodevelopmental disorder associated with impairment of cognitive function as a central feature, which is confirmed by a number of studies performed on patients suffering from Sch, where clinical symptoms and social functioning of patients are consequences of neurocognitive deficits. Goal: The goal of this study was to assess the clinical usability of the Montreal Cognitive Assessment (MoCA) as a screening instrument for cognitive impairment in schizophrenic patients, alone and in correlation with the Mini-Mental State Examination (MMSE). Material and methods: This clinical prospective study included 30 patients diagnosed with schizophrenia. Patients were selected from Psychiatric Clinic, Clinical Center University of Sarajevo (CCUS) during 2010. For assessment of cognitive impairment we used Montreal Cognitive Assessment Scale (MoCA) and Mini-Mental State Examination (MMSE). Results: From the total number of respondents (n=30), 15/30 (50 %) were males and 15/30 (50 %) were females; age of onset were 23.5±6.69; duration of illness before hospitalization (mean±SD) 32.5±12.9. If we make a comparison of MoCA scale and MMSE under the limit values, then we get that there was 10 true positive, 4 true negative, 14 false positive and 2 false negative. This all leads to sensitivity of MoCA scale again in comparison with the MMSE of 41.7%, specificity 66.7%, positive predictive value of 83.3% and negative predictive value of 22.2%. Conclusions: Our findings provide preliminary evidence that MoCA scale performs well in detecting true positive but it is imprecise in the detection of true negative findings.

Introduction: Psychiatric disorders have been considered to have seasonal variation for a long time. Goal: The goal of this research is to study the admissions rate of neurotic and somatoform disorders, as well as stress induced disorder in relation to season and climatic factors during 2010/2011. Material and method: The research was conducted at the Psychiatric Clinic, Clinical Center of University in Sarajevo. Randomly selected subjects (aged 5-89 years, 1316 males and 1039 females) N=2355, were interviewed by the Structural Clinical Interview (SCID) which generated DSM-IV diagnoses. In this retrospective-prospective, clinical-epidemiological study subjects were divided into groups according to type of disorders. Correlation between the impact of seasons and the rate of admissions to a Psychiatric clinic was analyzed. Certain data were taken from Federal Hydrometeorological Institute in Sarajevo about the climatic situation for period of the study. Results and conclusions: From the total number of subjects who were admitted to the clinic in the period of 2010/2011 the most common diagnoses were F10-F19, F20-F29, F30-F39, F40-F48, and the suicide attempts as the separate entity. It was found the correlation between certain seasons and the effects of the certain weather parameters at an increased admission rate of subjects with the neurotic, somatoform and stress induced disorders.

Introduction: Climate and its impact on human health and mental illness have been in the focus of the research since years in the field. Aim: The aim of the research is to study the admissions rate to the psychiatric clinic in correlation to seasons and climate. Material and method: The research was conducted in a Psychiatric clinic of the Clinical Center in Sarajevo. Randomly selected subjects (aged 5-89 years, 1316 males and 1039 females) N=2355, were interviewed by the Structural Clinical Interview (SCID) which generated DSM-IV. In this retrospective-prospective, clinicalepidemiological study subjects were divided into groups according to type of disorders. Correlation between the impact of seasons and the rate of admissions to a Psychiatric clinic was analyzed. Certain data were taken from Federal Hydrometeorological Institute in Sarajevo of the climatic situation for period of the study. Results and conclusions: Of the total number of subjects who were admitted to the clinic in the period of 2010/2011 the most common diagnoses were F10-F19, F20-F29, F30-F39, F40-F48, and the suicide attempts as the separate entity. It was found correlation between certain seasons and the effects of the certain weather parameters at an increased admission rate of subjects with the certain diseases.

Introduction: Numerous epidemiological international studies as well as knowledge based on clinical experience show high prevalence and the importance of the psychiatric comorbidity with depressive and anxiety disorders. Goal: The aim of this study is to analyze prevalence of comorbid anxiety disorders and depression in subjects at the Day Hospital of the Psychiatric Clinic, Clinical Center of Sarajevo University (CCUS) and examine the demographic profile of the patients. Material and methods: Study involved 230 randomly selected patients (aged between 18 and 65 years, N=230, who were hospitalized at the Day Hospital of the Psychiatric Clinic of Clinical center of University of Sarajevo from January 1st to December 31st 2011) and who were interviewed by the Structural Clinical Interview (SCID) which generated ICD-X diagnoses and assessment of the comorbidity. Depressive symptoms were assessed by Beck’s Depression Inventory with 28 items. Anxiety symptoms were assessed with Beck’s Anxiety Inventory scale with 21 items. Study is retrospective, clinical and epidemiological. Results: Of the total number of patients (230) it was determined that 107 (46.5%) have depressive episode; 71 (30.9%) anxiety disorder. Comorbidity of these two disorders was found in 14 (6.1%) cases. Anxiety disorders were more represented in women (61.2%), as well as depressive disorders and comorbidity (70.1% and 85.7%). Subjects with depression on average was 52.9±7.4 years old (range 29-64 years), patients with anxious disorders 50±9.5 years (range 22-65 years) while patients with comorbidity of these two entities was at mean age of 54.5±4.5 years. The least common category of education was retired persons and respondents with university education for all three entities. Hospitalization duration for depression, anxiety, and comorbidity of these two disorders is highest for depression (47.1±9.7 days) and shortest in case of comorbidity (45.9±6.9 days). Conclusion: Depression and anxiety often coexist. When they occur in comorbidity, both anxiety and depression appear to be more severe. Severely depressed and anxious patients have reduced capacity to work and as such represents a considerable burden to the family and the community. Overview of depression, anxiety and the comorbidity of these two diagnoses (listed as primary diagnosis) in the baseline sample showed that there was most patients with depression (107 or 46.5%), followed by anxiety (71 or 30.9%) and comorbidity with 14 patients or 6.1%. Effective assessment, evaluation, diagnosis and treatment can lead to better treatment outcomes in primary care and improved quality of life.

PROFESSIONAL PAPER SUMMARY Introduction: Clinical experience and epidemiological, clinical international studies show a high prevalence and significance of psychiatric co- morbidity of depression and anxiety disorders. Goal: The goal of this study was to analyze the comorbidity of anxiety disorders and depression in patients at a Psychiatric Clinic, Clinical Center of Sarajevo University (CCUS), and examine the demographic profile of the patients. Material and methods: The study included 1202 patients with different diagnoses, hospitalized at the Psychiatric Clinic CCUS from January 1st 2010 to December 31st 2010. Of this total was selected 491 patients with depressive and anxiety disorders. The intensity of depressive symptoms was assessed using the Hamilton Depression Rating Scale (HDRS), with 17 items, and anxiety symptoms were assessed by Beck Depression Inventory Scale with 21 items. The study was retrospective, clinical and epidemiological. Results: Of the total number of patients (1202) 424 (35.3%) patients had depressive disorders and anxiety disorders in 57 (4.7%). Comorbidity of these disorders occurs in 10 (0.8%) of patients. Depressive disorders were more present among males (89.1%), while the anxiety disorders and comorbidity in women with 13% and 3%. Depressive disorders are more common (91.7%) among older respondents (over 65 years) and an anxiety up to 25 years of age (25%). Comorbidity was present in 2.6% in age from 26-45 years. Smallest representation had the category of pupils/students with depression, and respondents with university education, which are mostly represented with anxiety disorders. According to duration of hospitalization is highest for depression (over 90 days) and shortest in the case of anxiety (30 days). Conclusion: The results of clinical and epidemiological studies indicate a trend that anxiety disorders and depression occur in comorbidity (simultaneous or alternating) more often than other psychiatric disorders. Clinical experience and epidemiological, clinical international studies show a high prevalence and significance of psychiatric comorbidity of depression and anxiety disorders. Severely depressed and anxious patients have reduced capacity for work, and as such represent a considerable burden to family, community and society. Proper diagnosis, monitoring and treatment leads to better and higher quality of life. Required is a further research of this complex phenomenon on a larger sample in order to improve prevention that is still inefficient.

Epileptic psychoses as the most complex psychopathological phenomena represent unexplored states for prognosis. Clinical trials, conveyed in order to found risk factors still are not consistent in their conclusions. By this research results of all biological, clinical, psychological and social, as well as demographic factors will contribute to opportunity to find variables which could finally prevent these conditions. In this study we tried to evaluate clinical variables which could foresee manifestation of interictal and postictal psychosis. This research study is epidemiological, clinical, retrospective and analytical. In total 567 patients were included in this study, which belonged to the diagnostic criteria F 0.6 according to ICD-10 classification, among which 14 patients with the diagnosed epileptic psychosis (06,8) were followed. All patients were hospitalized and evaluated at the Psychiatric Clinic in University of Sarajevo Clinics Centre, during time period between 01.01.2000 - 31.08.2006. Within baseline all relevant clinical and demographic variables were evaluated. Among patients most dominant form of behavior was expansive, with emphasized paranoid ideations and perception of auditory hallucinations. A correlation between intensive psychological trauma as an exacerbation factor and prolonged illness is determined, as well as between expression of psychotic symptoms and forced normalization by antiepileptic medications. Also is proven that among postictal psychosis more dominant are suicide attempts and aggressive behavior.

OBJECTIVES An epidemiological, retrospective, and analytical study was conducted to evaluate frequencies of emergency conditions, gender, age and demographical differentials, thus highlighting all clinical and demographical parameters relating to suicide attempts. SUBJECTS AND METHODS Two Hundred and Sixty Eight (268) patients hospitalized in the intensive care unit of the Department of Psychiatry at the Sarajevo University Medical Centre over the course of a one-year period (01.01.2004 - 31.12.2004) were examined and included in the study. Essentially, the symptoms were assessed via psychiatric examinations and through the medical history of the patients. The data collected by the study were analyzed statistically by using the SPSS and Chi Square test. RESULTS 94% of all patients were hospitalized as being in an emergency situation, 6% were wrongly diagnosed and transferred into a relevant medical institution. 41% of patients were hospitalized at the point of crisis (with police and emergency medical staff), while the most frequent condition was exacerbation of schizophrenia (22.4%). Of the 94% of patients, 17.9% were suicide attempters, while the group at greatest risk was the youngest (18-24), although this group represents 4.5% of total. The other risk factors were male gender, age 30-49 years, single or divorced, and lower socioeconomic status. The most frequent means of attempted suicide was intoxication with medication. Nearly all the patients had made previous suicide attempts. DISCUSSION The study was conducted to provide an important epidemiological information on the characteristics of emergency admissions to psychiatric units and to underline the problem of triage and monitoring for this type of patients. How to prevent crises remains an open question; however this and other studies provide the necessary data to assist in managing and resolving this issue in the future.