Background Impulsivity, affective instability, and neglect of oneself and other people's safety as symptoms of personality dysfunction are associated with risky behaviors regarding the transmission of infectious diseases either sexually or by intravenous drug abuse. Objective The aim of this study was to analyze the association between hepatitis C virus (HCV) infection and personality dysfunction in opiate addicts on opioid substitution treatment. Methods This was a cross-sectional, observational investigation of patients over 18 years of age who were actively participating in opioid substitution treatment at five centers in Bosnia and Herzegovina. The occurrence of HCV infection was the primary study outcome, and personality functioning, the main independent variable, was assessed using the Severity Indices of Personality Problems (SIPP−118) questionnaire. The association between scores of personality functioning domains items and HCV infection status was determined by binary logistic regression analysis. Results Patients on opioid substitution therapy with HCV infection more frequently had personality disorders (OR 2.168, 95% CI 1.161–4.05) and were treated longer than patients without HCV infection (OR 1.076, 95% CI 1.015–1.14). HCV infection was associated with lower self-respect (OR 0.946, 95% CI 0.906–0.988), decreased capacity to have enduring relationships with other people (OR 0.878, 95% CI 0.797–0.966), and lower capability to cooperate with others (OR 0.933, 95%CI 0.888–0.98). On the other hand, except for self-respect, other elements of the Identity Integration domain (enjoyment, purposefulness, stable self-image, and self-reflexive functioning), when more functional, increased the risk of HCV infection. Conclusions Our study demonstrates that opiate addicts on opioid substitution treatment have a higher risk of HCV infection if their personality is dysfunctional, especially in the aspects of self-respect, enduring relationships, and cooperativity. The risk is even higher in addicts who have an established diagnosis of any kind of personality disorder.

Background: Coronavirus disease 2019 (COVID-19), like any other pandemic, has imposed an unprecedented threat to physical and mental health to all nations, worldwide. There is no enough evidence in the literature in this area. The present study has been done to explore the organization of psychiatric services in Bosnia and Herzegovina (BH) to meet mental health needs of BH citizens during the particular restrictive measures caused by COVID-19 pandemic. Materials and Methods: This online survey has been done for BH psychiatric institutions. Data were collected from psychiatric institutions in the mental health network of BH. A total of 38 complete responses have been received. Results: Of 38 study participants, three were the departments of psychiatry in university clinical centers, two were psychiatric hospitals, four were psychiatric wards in general hospitals, 27 were community mental health centers, and two were institutes for alcoholism and drug addiction. During the pandemic, all services functioned on a reduced scale, adhering to measures to protect and self-protect both staff and service users. Protective equipment was provided to staff in some institutions in a timely and complete manner and in some in an untimely and incomplete manner. Consultative psychiatric examinations were mainly performed through telephone and online, where it exists as a standard patient monitoring protocol. The application of long-acting antipsychotics was continuous with adherence to restricted and protective measures. In opiate addiction replacement therapy services, substitution therapy was provided for a longer period to reduce frequent contacts between staff and patients. Individual and group psychotherapy continued in reduced number using online technologies, although this type of service was not administratively regulated. An initiative has been given to regulate and administratively recognize telepsychiatry by health insurance funds in the country. A number of psychological problems associated with restrictive measures and fear of illness have been reported by patients as well as by the professionals in mental healthcare teams. There were no COVID-19-positive patients seeking help from institutions that responded to the questionnaire. In one center, infected people with COVID-19 from abroad sought help through the phone. Only one involuntary hospitalization was reported. The involvement of mental health professionals in the work of crisis headquarters during the design of the COVID-19 pandemic control measures varies from satisfactory to insufficient. Education of staff, patients, and citizens was regular with direct instructions through meetings, press, and electronic media. Conclusions: During the COVID-19 pandemic in BH, all psychiatric services functioned on a reduced scale, adhering to measures to protect and self-protect staff and service users. All patients who asked for help have been adequately treated in direct inpatient or outpatient mental healthcare or online, despite telepsychiatric services not being recognized in health system in BH. There were neither infected patients nor staff with COVID-19 in the psychiatric institutions who responded in this research. A large-scale, multicenter study needs to be performed to get a broader picture and to guide us for future better service planning and delivery.

BACKGROUND The attitude of health care professionals towards job is determined by the degree of their ability to work with addicts, educational and cultural factors, as well as the psychological profile of their personality, on which depend their emotional response in work with addicts. AIM To explore the therapist's relationship to job, whether that relationship has an effect on their affective status, and to what extent that relationship can lead to the development of tension (anxiety) during the treatment of opiate addicts. SUBJECTS AND METHODS The sample consists of members of the multidisciplinary teams of the Institute for Addiction Disorders of Canton Sarajevo (45 in total), of which 11 are physicians, 26 nurses/medical technicians, 4 psychologists and 4 social workers. Employee Attitude Questionnaire (16 questions examining level of information, feelings of insecurity, fatigue, teamwork and job satisfaction) and EMAS-S which has two subscales (for measuring cognitive worry factor and autonomic-emotional anxiety state factor) were used. RESULTS From baseline, 32 (71%) of respondents have the opportunity to apply their knowledge and skills at workplace, which is proportional to their job satisfaction, reduction of anxiety and uncertainty. A large proportion of respondents 36 (80%) stated that they felt more responsible in their work compared to the beginning of career, which was followed by a decrease in the score on EMAS cognition and emotion subscale, what reflected positively on work efficiency. The degree of satisfaction at the end of the work day, often and almost always, has 60% of respondents. CONCLUSION Employees who feel satisfaction at work, who improve their knowledge and work in a team, have a better attitude towards work and less anxiety, and achieve better results when working with addicts.

The Goal: The goal of this study was to determine the effect of psychoactive substances (drugs) on the presence and frequency of oral Candida species and Candida dubliniensis. Materials and methods: For the purpose of achieving the set goals, we chose a sample. Sixty bed-ridden patients from the Institute for Alcoholism and Other Addictions in Sarajevo Canton, both males and females between 18 and 60 years of age, were included in the research and assigned to two different groups (alcohol addicts and opiate addicts). After extensive anamnesis and a clinical examination, samples of oral epithelia were taken for microbiological identification. Two confirmatory methods were used for the identification of Candida species: the blastesis test and cultivation in a chromatophilic medium (Chrom agar). A yeast assimilation test (API test) was used for the identification of non-albicans Candida. A separate test was used to identify Candida dubliniensis (PAL agar). Results: The results of the microbiological analysis confirmed the frequency of Candida albicans (43%) in psychoactive substance addicts, as well as an increase in non-albicans Candida regardless of the type of addiction (34%). The presence of Candida dubliniensis was proven in psychoactive substance addicts (23%) and it was confirmed that the frequency of bacterial adherence of Candida dubliniensis is directly proportional to the duration of the drug-addiction. Conclusion: The abuse of psychoactive substances has an effect on the frequency of albicans and non-albicans species of oral Candida. Based on the findings, we have concluded that psychoactive substances (opiates and alcohol) lead to an increase in oral Candida dubliniensis regardless of the type of addictions.

In the aftermath of the war in Bosnia Herzegovina, a task group of Swedish experts organised and supported training of community psychiatry and social work as part of the mental health reform. Among the basic principles of the programme were a close cooperation with the Ministry of Health, personal continuity, exchange of knowledge and long term engagement. With the support of the programme, community mental health centres were created and staffed with a team consisting of: a psychiatrist, four nurses, a psychologist and a social worker. They catered, on average, for 65,000 people of all ages and saw 25–30 patients a day. Of these patients, 75% had psychiatric problems. Among the trained personnel, a major attitude shift occurred in favour of community psychiatry. As a result of the training, informal networks between local professionals were established. An evaluation, four years after the project ended, found that the community mental health centres were the major providers of psychiatric services in the region.

There is a clear evidence that same psychoactive substance may cause various individual physiological reactions in same environmental conditions. Although there is a general attitude on equal liability to opioid addiction, latest genetic analysis findings imply there are certain quantifiable factors that could lead to elevated individual liability towards development of opioid addiction. The goal of this study was to investigate association of certain personality traits and genetic factors (separately and in combination) with heroin addiction. Total of 200 individuals participated in the study: 100 patients on Metadone Maintenance Treatment (MMT) and 100 age and sex matched healthy volunteers. All were medically examined, interviewed and psychologically evaluated using Eysenck personality questionnaire (EPQ) and genotyped for DRD2 (rs1800497) using PCR-RFLP method. Overrepresentation of certain personality traits (neuroticism, psychoticism and extraversion/ intraversion), together with environemental risk factors such as: upbringing within incomplete families and familial history of psychotropic substances abuse, are associated with high-risk development of opioid addiction.

Chronology of important historical events in Bosnia and Herzegovina during past two centuries indirectly influenced the incidence and prevalence of different psychoactive substances use and thus the organization of services for the treatment of persons who develop addiction symptoms. The organization of health system in the last war, 1992-1995, suffered enormous damage and the reform process which inevitably followed, included the area of mental health care services and the establishment of network of centers for mental health in the community (CMHC). The centers are functioning within the primary health care almost in whole country, with specialized centers for the prevention and treatment of addicts and the therapeutic communities, which today represents the basic organizational units to help people who have drug related issues. In this paper we will present the possibility of treatment of drug addicts in Bosnia and Herzegovina, from consulting services, psycho-education and early detection of disease, detoxification and substitution programs with Methadone and Suboxone, as well as programs of rehabilitation and resocialization. Although a very complicated political and administrative structure of the country, insufficient financial support, pronounced stigmatization of addicts, insufficient staffing and number of treatment centers are objective obstacles for progress in treatment of addicts, we believe that, with existing resources, these constraints can be converted into new opportunities in terms of improvement of treatment options in the future.

UNLABELLED Paroxismatic psychical disorders, as attacks of panic and anxiety, de-realization, de-personalization, false reconescense phenomena and other are, represent the diagnostic problem. The possibility of mistake is significant, and wrong diagnosis has medical and social implications. The aim was to point out the methodology of the work with these patients. METHOD From the group of patients with resistant epilepsies, we have separated five patients, which are very instructive. Three of them have been on anti-epileptics for 2.5 up to 4 years (partial complex attacks), two on psycho-pharmacies and one on psycho-therapy (as pseudo-attacks). The complete history of the disease have been taken with all patients, together with simultaneous consultations with psychiatrist, laboratory and cardiology status, EEG registrations, and with three patients the whole-night poly-somnogram (Vrapce), CT and MRI of the brain. RESULTS Three patients with "resistant epilepsy" did not have epilepsy, but were psychiatric cases, although two patients were partial complex epilepsies (pseudo-attacks before). DISCUSSION The diagnosis of paroxysmal psychic disorders has to be all-inclusive. It has to have included maximal diagnostic criteria for the epilepsy, together with obligatory consultation (synchronal) with psychiatrist. Some characteristics of epileptic attacks may be the direction-signs: they are short, repeating more or less on stereotype way, accompanied with automatisms, and especially important are post-attack conditions (conditions of confusion). If paroxysms are of less sharp borders, last longer, less stereotype, and especially if there is no post-ictal shows, more probably are psychiatric cases. CONCLUSION 1. For the exact diagnosis of paroxysm, the overall consideration, the close cooperation between epileptologist and psychiatrist are needed, 2. The maximal diagnostic criteria for epilepsy are conditio sine qua non.

INTRODUCTION Number of addicts increased in our country, especially after the war, and needed adequate solution of the problem as well as use of the experiences from the other countries that faced before us "epidemy" of addictions. One of the solutions for harm reduction caused by use of opioid substances, primarily heroin, is use of methadone (heptanone), which is a good pharmacological replacement. METHODS In this paper we have presented one-year experience in application of methadone for detoxification or substitution among the patients in our Institute. This retrospective-prospective study included 104 patients treated by methadone detoxification therapy and 59 patients included in the program of methadone substitution. This study involves analyses of the applied therapy compared to age, gender, profession, and duration of addiction, employment status and other social and demographic indicators. RESULTS Methadone detoxification therapy. Among all age groups most dominant are addicts age 21-30 years (71%), and some in the age group 30-35 years (18%). Lack of adequate treatment programs, as well as break in continuity of treatment due to the war in our country, caused that we have in our sample 10% patients older than 36 years. Few patients younger than 20 years of age, we can explain with short working age of your department, but even now we can notice the incensement of young addicts number. First contact with the drug our addicts usually have between 13 and 18 years of age (61%), while earliest age of contact was 11. Duration of addiction is usually from 1 up to 9 years (65%), although we cannot neglect the number of addicts who are using the drug more than 10 years (35%). During our work, up to now, we did not have neither one case of HIV infection, which does not means that this disease is not present in the addicts population that we have not tested yet. Number of Hepatitis B and C positive addicts in our sample is in accordance with epidemiological data from other countries. There was 32% Hepatitis B positive, 58% Hepatitis C positive, and 23% Hepatitis B and C positive. Methadone substitution therapy. Among those included in the MST, male patients are most dominant, with average age of 31.4 years. Majority of patients has finished high school, they are unemployed, single, and living with their parents. First contact with drugs they had in average age of 16.4 years, while the duration of use had mean value of 10 years. Initial maintenance doses were between 10 and 50 mg, mean 36.1 mg, and maintenance doses after the two months had mean value of 61.6 mg. Among patients involved in MST, we have noted one HIV positive case, and significantly larger number of patients that are positive on Hepatitis: Hepatitis C 33%, and Hepatitis B and C (34%). CONCLUSIONS Our experience during the application of both treatment types is positive. This treatment is well accepted by the addicts. The MDT and MST methods provides better functioning, easier follow up and better participation in the social and psychological therapeutic processes, which are conducted at our department. Positive improvement in social functioning. Better motivation for the continuation of treatment in the other institutions (therapeutic community). We did not have any side effects of the treatment in order to stop the therapeutic process. We need continuous education and sensibility of the whole society and political community in order to accept, finance and maintain methadone programs.

Hazardous and harmful use of alcohol and drugs, accompany human race for centuries, and represents transcultural phenomena as well as one of the problems that still does not have solution. According to consequences that it's causing to individual, family and community it is one of the most severe social problems. Although, international community is investing more and more efforts and money to prevent illicit drug traffic, reduce consumption of alcohol and improve prevention, treatment and rehabilitation of addicts, still some significant results are not reached. War in Bosnia and Herzegovina cause severe injuries to population and left devastation and misery. War crimes are reflected in 200,000 deaths, several thousand wounded and over one million traumatized. Transition societies, as our, are characterized with big social changes such as migrations, urbanization and destruction of traditional social values. Due to this extensive drinking and drug use, as a form of escape from the reality and social difficulties are characteristic of our society and current civilization. It is estimated that currently in B&H exist 10,000 opioid addicts, and 20,000 alcoholics. Rapid incensement in number of addicts, and problems caused by that was the reason why we after the war started with preparations of Preventive Programme with focus on primary prevention. Beside programs that was made on the local levels, during 2002 Federal Programme of prevention was accepted which anticipated activities at all three preventive levels.

Psychiatric services in Bosnia-Herzegovina before the war disaster was fairly developed and one of the best organized services amongst the republics of the former Yugoslavia. The psychiatric care system was based on psychiatric hospitals and small neuropsychiatric wards within general hospitals, accompanied by psychiatric services in health centers. The onset of war in B&H brought devastation and destruction in all domains of life, including the demolition and closing of numerous traditional psychiatric institutions, together with massive psychological suffering of the whole civilian population. Already during the war, and even more so after the war, the reconstruction and reorganization of the mental health services was undertaken. The basis of mental health care for the future is designed as a system where majority of services is located in the community, as close as possible to the habitat of the patients. The key aspect of the system of the comprehensive health care is primary health care and the main role is assigned to family practitioners and mental health professionals working in the community. Large psychiatric institutions were either closed or devastated, or have their capacities extensively reduced. There will be no reconstructions or reopening of the old psychiatric facilities, nor the new ones will be built. The most integrated part of the psychiatric system are the Community based mental health centers. Each of these centers will serve a particular geographic area. The centers will be responsible for prevention and treatment of psychiatric disorders, as well as for the mental health well being. Chronic mental health patients without families and are not able to independently live in the community will be accommodated in designated homes and other forms of protected accommodation within their communities. The principal change in mental health policy in B&H was a decision to transfer psychiatric services from traditional facilities into community, much closer to the patients. Basic elements of the mental health policy in B&H are: Decentralization and sectorization of mental health services; Intersectorial activity; Comprehensiveness of services; Equality in access and utilization of psychiatric service resources; Nationwide accessibility of mental health services; Continuity of services and care, together with the active participation of the community. This overview discusses the primary health care as the basic component of the comprehensive mental health care in greater detail, including tasks for family medicine teams and each individual member. 1. Comprehensive psychiatric care is implemented by primary health care physicians, specialized Centers for community-based mental health care, psychiatric wards of general hospitals and clinical centers in charge of brief, "acute" inpatient care; 2. Primary mental health care is implemented by family practitioners (primary care physicians) and their teams; 3. Specialized psychiatric care in community is performed professional teams specialized mental health issues' within Mental health centers in corresponding sectors; 4. A great deal of relevance is given to development of confidence and utilization of links between primary health care teams and specialized teams in Mental health centers and psychiatric in patient institutions; 5. Psychiatric wards within general cantonal hospitals, departments of psychiatric clinics in Sarajevo, Tuzla, and Mostar, and Cantonal Psychiatric hospital in Sarajevo (Jagomir) shall admit acute patients as well as chronic (with each new relapse). Treatment in these facilities is brief an patients are discharged to return to their homes, with further treatment referral to their family practitioner or designated Mental health center; 6. Chronic mental patients with severe residual impairment in social, psychological, and somatic functioning, shall live in the community with their families or independently. Those chronic patients without families and economic and other resources to live independently shall be placed in supervised Homes in the communities where they live. The above delineated strategy of mental health care program in B&H has several fundamental and specific objectives, among which the most important are: Reduction of incidence and prevalence of some mental disorders, particularly war stress-related disorders and suicide; Reduction of level of functional disability caused by mental disorders through improvement of treatment and care of individuals with mental health problems; Improvement of psychosocial well being of people with mental health problems, through implementation of comprehensive and accessible service for community mental health care; and Respect of basic human rights of individuals with mental health disabilities. The program has been updated since 1996, after the two-year pilot program. The main goals for current two- and five-year period are: Implement the mental health care reform program by launching all 38 Mental health centers in the Federation of BiH by 2002; Complete the 10-day education and re-education of at least 50% of all professionals employed in mental health services in FB&H by 2002; and Achieve that 80 percent of all mental health problems are treated by family medicine teams (primary care practitioners) and specialized mental health services (Community mental health care centers) by 2005.

The motive for the realization of the program prevention of the dependence on at primary school, is the knowledge that in our country last years the mental health of children and young endangered also the war which always represents the factor of high risk for psychic development and health. The experiences show that without collaboration between the different experts who are treating with the children and the adolescents has no efficacious prevention, protection, and treatment of dependence on. The better knowing of the normal psychic development leads to better knowing of the disorders and increases the successfulness of the intervention. In this paper is demonstrated the model of the program of the prevention of the dependances applied at the primary school "Edhem Mulabdich". The realization of this program ran through two phases: I-"educator education" for the teachers of the class and subject teaching and II-training program for the selected group of the teachers carriers of the preventive activities. This program we concipated so that through the structurized activities realize the following tasks: education from the different fields of the relevant for the problem of dependency, the development of the skills of the recognition of the pupils for the use of the means of dependensies: The animiting of the school environment so that the problem of dependency on the adequate manner would build in into the regular school activities the development of the expert net and institutions which will intervene in the definite cases. The application of this model for the prevention program of dependency pointed to the possibilities of the efficacious acting at school conditions, with the obligation that in the efficacious acting in school condition, with the obligation that in during the continued application the permanent gets tested, complete and adapt appropriately the requests of the community and scientific knowledges.