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N. Aljukić, M. Hasanovic, I. Pajević, E. Becirovic, Anel Brigić

Introduction: Globally, the most common mental disorders in the elderly include dementia (5% - 8%), depression (7%), anxiety disorder (4%), and substance abuse (1%). Moreover, 25% of suicide deaths occur among the elderly. Whether the prevalence rate of psychiatric disorders increases in later life is currently debated in the literature. During the previous two decades of their lives, older adults in Bosnia and Herzegovina have experienced many specific psychosocial circumstances. The experience of war aggression on our country, and the post-war period with a very complex socioeconomic environment of the current socio-political climate, were accompanied by special challenges for the mental health of this population. Motivated by a large number of questions and dilemmas related to the state of mental health of this population, we conducted research at the Department of Psychiatry at the University Clinical Center Tuzla.Objective: Our objective was to investigate psychiatric morbidity and comorbidity in people over 55 years of age.Methods: The research sample consisted of all patients older than 55 years treated at the Department for Psychiatry during 2018 (N=281), divided into four age categories. To obtain data, we used medical documentation, i.e., medical records, and we constructed a special questionnaire for research purposes.Results: Diagnoses by ICD-10 groups: 33.4% of patients in the entire sample had affective disorders (F30.0-F39.0): "young" (39.2%), "middle" (43.3%), "older "(75%) (p<0.001); women had significantly more affective disorders (61.8%) than men (26.8%) (p<0.001). Men had significantly more organic mental disorders (F00.0-F09.0) (63.3%) than women (22.6%) (p<0.001).Hypertensio arterialis was the most common comorbid dg. of the entire sample, without significant differences according to age groups and sex (p>0.05). Diabetes mellitus was the second comorbid dg. By frequency in the total sample (19.6%) without significant differences according to age groups and according to sex (p>0.05).Conclusion: In the entire sample, the most common diagnoses are from the affective disorders group; the most common somatic comorbidities are hypertensio arterialis and diabetes mellitus.

N. Kravić, I. Pajević, M. Hasanovic, Nejla Karahasanović, M. Voracek, E. Baca-García, K. Dervic

Abstract More research on the medium- and long-term effects of childhood exposure to war, including orphanhood, is needed. We compared 50 orphans1 who lost their father during the war in Bosnia and Herzegovina (1992–1995) and 50 age- and sex-matched adolescents from two-parent families during 2011–2012 in terms of sociodemographic characteristics, behavioral/emotional problems, depression, resilience, maternal mental health, and perceived social support. The two groups differed on sociodemographic factors, that is, number of children, family composition, income, school grades, and refugeehood. Paternal war orphans did not differ in terms of adolescent mental health and resilience from their nonorphaned peers, controlling for sociodemographic variables. The mothers of orphans had comparably more posttraumatic psychopathology. As for perceived resources for social support, orphans identified those comparably more often among distant relatives and in the community, that is, religious officials and mental health professionals, and less often among siblings, paternal grandparents, paternal and maternal uncles/aunts, school friends and teachers. Our findings suggest that contextual factors may play an important role in orphans' postwar mental health.

N. Žigić, I. Pajević, M. Hasanovic, E. Avdibegović, N. Aljukić, V. Hodzic

Introduction Posttraumatic stress disorder in the paediatric population has clinical features. The Clinician-Administered PTSD Scale for DSM-5,child and adolescent version (CAPS-CA-5) is the gold standard for the positive diagnosis. Objectives The objectives of our work were to translate the CAPS-CA-5 into Tunisian dialectal Arabic and to validate it in our Tunisian sociocultural context. Methods This is a descriptive cross-sectional study conducted in the child psychiatry department of Mongi Slim Hospital and the forensic medicine department of Charles-Nicolle Hospital (Tunisia), among children older than seven years who were exposed to a potentially traumatic event at least one month before. We validated the tool through translation, content, construct validity and reliability. The statistical processing for this data was carried out using SPSS 26 software. Results We conducted our study with 150 patients. The validation was made on 146 records after the exclusion of 4 incompleted assessments. We initially translated the CAPS-CA-5 into Tunisian dialect. We validated the content through pre-test and scientific committee evaluation. Afterwards, we validated the construction. We calculated the Bartlett’s sphericity test (p<0.001) .The KMO index that was 0.766. Concerning the reliability study, we found a Cronbach’s alpha coefficient equal to 0.92. We studied also the inter-raters reliability; we found an intra-class coefficient between 0.8 and 1 Conclusions We validated the first Tunisian diagnostic tool for PTSD in children according to the DSM-5 criteria with satisfactory psychometric qualities. Disclosure of Interest None Declared

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.

S. Skočibušić, N. Zivlak-Radulovic, M. Hasanovic, H. Awad, Dragana Karan-Križanac, N. Mehić-Basara, T. Rukavina

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.

O. Sinanović, I. Pajević, M. Hasanovic, M. Jakovljevič

s have we learned about the consequences of the COVID-19 16. Javed A: Mental health challenges during COVID-19 pandemic. Book of abstracts of the International Scientific Symponces of the COVID17. & : Mental health challenges during COVID-19 pandemic. tracts of the learned about the consequences of the COVID-19 18. Kes P: Acute kidney injury in patients with COVID-19. In: a have we learned about the consequences of the COVID-19 19. Kurjak A: Is the COVID-19 pandemic the end of happy globalization what was the scientific response? In: abstracts of the have we learned about the consequences of the COVID-19s of the have we learned about the consequences of the COVID-19 20. Leonardi F: The Definition of Health: Towards New Perspectives. Int J Health Serv 2018; 48:735-748 21. -Dinar S: Postcovid-19 in children evaluation of immunological and coronary artery status. In: abstracts of the Internation have we learned about the consequences of the COVID-19 pandemi 22. Mesihovic-Dinarevic S & : Post-coronavirus disease 2019 children in Sarajevo-Lessons learnt? J Health Sciences 2021; 11:93 97 23. Muf : Post-COVID-19 syndrome rehabilitation. In: s). Book of have we learned about the consequences of the COVID-19 24. Niki M: The COVID-19 pandemic call to conversion and return to God: a view from the perspective of Catholic theology. Book of abstracts of the International Scientific Symposium consequences of the COVID25. Radmanovi : COVID-19 pandemic shepherd challenges for Orthodox church. I & : "WHAT HAVE WE LEARNED ABOUT THE CONSEQUENCES OF THE COVID-19 PANDEMIC?" INTERNATIONAL SCIENTIFIC SYMPOSIUM ORGANIZED IN TUZLA IN BOSNIA-HERZEGOVINA Psychiatria Danubina, 2021; Vol. 33, No. 3, pp 427-437 437 we learned about the consequences of the COVID-19 rajevo, 2021 26. Sinano O: Long-term neuropsychiatric consequences of SARS-CoV infections. Psychiatr Danub 2021; 33(Suppl 3):S309-S317 27. : Association of sense of smell and taste disorders with SARS-CoV-2 infection. of abstracts of the learned about the consequences of the COVID-19 28. & : Covid-19 pandemia: neuropsychiatric comorbidity and consequences. Psychiatr Danub 2020; 32:236-244 29. & Pajev I: The Book of What have we learned about the consequences of the COVID-19 pandemic? IANUBIH: Sarajevo, 2021. https://ianubih.ba/2021/10/22/medjunarodni-naucnisimpozij-sta-smo-naucili-o-posljedicama-covid-19pandemije-knjiga-sa/ 30. Seljubac S: COVID-19 pandemics: a test or punishment Islamic perspective. nal consequences of the COVIDSarajevo, 2021 31. : COVID-19: respiratory disorders. In: Sinan O, Hasano International Scien learned about the consequences of the COVID-19 32. : Mother and newborn during the COVID-19 pandemic: between Sci k of abstracts of the e learned about the consequences of the COVID-19 33. Trkanjec Z: COVID-19 and Parkins In: a have we learned about the consequences of the COVID-19 34. Umakanthan S, Sahu P, Ranade AV, Bukelo MM, Rao JS, Abrahao-Machado LF, Dahal S, Kumar H & Kv D: Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19). Postgrad Med J 2020; 96:753-758. doi:10.1136/postgradmedj-2020138234. Epub 2020 Jun 20. PMID: 32563999

Ahmed Pajević, I. Pajević, M. Hasanovic, M. Jakovljevič

Ibn Sina (Avicenna) is primarily known for his philosophy and medicine, but there is almost no scientific discipline in which this great man didn't leave a significant mark. This paper gives a brief overview of his contribution to medicine and psychology through which his unique scientific and religious approach to the study of the phenomena of human being can be best seen. Medical works of Ibn Sina represent a pinnacle of most important medical achievements of his time. These works contain synthesis of all Greek, Indian and Iranian medical schools, but also new breakthroughs achieved by Muslim scholars through their own experimentation and practice. Although he wrote many medical works, his most important one is El-Kanun fit-tib, which can be translated as The Canon of Medicine. It's made out of five books which systematically show everything known in the area of medicine up until that point in time. In it, Ibn Sina discusses, among other things, the structure of psychological apparatus of human being and the connection of psychological functions with the brain. He considered psychology to be very important for medicine, so in his psychological works he discusses, in great detail, the essence of human soul, consciousness, intellect and other psychological functions. He observed a man in his entirety, taking into consideration all aspects of his existence, paying special attention to spiritual knowledge and spiritual perfection, religiosity, and methods of achieving inner peace and well-being.

Elvira Ališahović-Gelo, M. Hasanovic

Car accident victims can suffer from an acute stress reaction and post-traumatic stress disorder. In the therapeutic method of desensitization and reprocessing with eye movements (Eye Movements Desensitizing Reprocessing EMDR), trauma with a large "T" includes events that a person perceives as a life-threatening. These events are so saturated, stressful, that they can overcome our usual capacity to fight (Herman 1992). They result in intense fear, extreme feelings of helplessness, and complete loss of control. Symptoms of post-traumatic stress disorder (PTSD) manifest in two types of simultaneous and diametrically opposed behaviors. In one type, the traumatized person cannot escape their trauma, they are forced to get rid of the original event through intrusive symptoms such as flashback episodes, nightmares, panic attacks, and obsessive thoughts. In the second, they, again, must not approach trauma: they are completely isolated from the recollection of trauma by avoiding symptoms and anything that can be associated with the event, such as social isolation, emotional stiffness, and substance dependence. Victims of trauma also have physiological reactions such as insomnia, hypervigilance, and a tendency to be easily intimidated by any recollection of an event, such as a single sound or touch (Shapiro 1997). In the approach to the treatment of PTSD, physicians most often opt for psychopharmacotherapy by combining antidepressants such as selective serotonin reuptake inhibitors, anxiolytics, mood stabilizers, hypnotics, and atypical antipsychotics (Hasanovi et al. 2011, 2013). The relative short-term efficacy and long-term benefits of pharmacological and psychotherapeutic interventions have rarely been studied for posttraumatic stress disorder (PTSD). Different types of psychological therapy have been proposed in the treatment of trauma, including exposure therapy, cognitive therapy, psychodynamic therapy, and EMDR. EMDR is currently an effective psychological treatment, recognized and recommended as the first line of trauma treatment in a number of international guides (Boccia et al. 2015). In Bosnia and Herzegovina, education for mental health workers EMDR was organized in 2009, and in 2014 Association of EMDR Therapists in Bosnia and Herzegovina was established (Hasanovi et al. 2018, 2021). Accordingly, our capacities to use EMDR in everyday treatment of traumatized patients became a reality (Ališahovi -Gelo & Hasanovi 2018, Hrvi & Hasanovi 2018, Imširovi & Hasanovi 2018, Kokanovi & Hasanovi 2018, Pašali & Hasanovi 2018, Omeragi & Hasanovi 2018, Smaji -Hodži & Hasanovi 2018, Siru i & Hasanovi 2018). The aim is to show the case of a patient who responded favorably to EMDR therapy but did not respond favorably to pharmacotherapy and superficial supportive treatment

Ivana Trlin, M. Hasanovic

Eye movement desensitization and reprocessing (EMDR) is an integrative psychotherapy that has been extensively evaluated in its approach to trauma and posttraumatic stress disorder (PTSD). In brief, the AIP model is based on the idea that the neurobiological system naturally attempts to process current perceptions in a manner that promotes associations to relevant stored information, to facilitate learning, and to relieve emotional distress. The resulting transfer of information from implicit to explicit memory systems (Shapiro 2001) allows disturbing thoughts, emotions, and bodily sensations to be resolved by facilitating access to the stored material and linking it with more adaptive information. However, the intense effect and subsequent dissociation that accompany trauma may interfere with this process, causing the information (e.g., images, thoughts, emotions, and sensations) to be dysfunctionally stored within the memory network. Because the event is isolated within the network, preventing associations with adaptive information, the unresolved material is easily triggered during similar encounters, often leading to intrusive thoughts, emotions, and somatic responses. The consequent habitual response patterns can manifest in characterological difficulties, psychopathology, and the avoidance behaviors associated with phobias and panic disorders (Shapiro 2001, 2002). EMDR s ability to access and target an etiological conditioning event is appreciated and it is also possible to address past, present, and future symptoms in the absence of a known etiological event. Thus, EMDR has the ability to address panic and phobia regardless of the method by which the symptoms, or fear, were acquired. Once the appropriate targets are chosen, the EMDR protocol addresses all experiential components (images, thoughts, emotions, bodily sensations) to stimulate the information processing system as explained by the AIP model (Shapiro 2001, 2002). EMDR was introduced in Bosnia and Herzegovina (BH), in 1998 just three years after the war (19921995). The first training was organized in 2009, and in 2014 Association of EMDR Therapists in Bosnia and Herzegovina was established (Hasanovi et al. 2018). So the mental health workers who were properly educated started to use EMDR therapies in everyday helping to BH citizens in need (Trlin & Hasanovi 2018, Hasanovi et al. 2021). The aim of the following case to present how EMDR treatment was used to successfully address panic disorder with agoraphobia.

M. Hasanovic, Siân Morgan, S. Oakley, S. Richman, Irma Omeragić, Nejra Siručić, I. Kokanović, Fadil Imširović et al.

INTRODUCTION Due to the increased needs of the citizens of Bosnia and Herzegovina (B&H) affected by the 1992-1995 war, after five basic EMDR (Eye Movement Desensitisation and Reprocessing) trainings and one EMDR training workshop for children and adolescents, Trauma Aid UK (former Humanitarian Aid Program UK and Ireland) continually provides supervision to mental health professionals in B&H, working towards European EMDR Association accreditation for the clinicians. To describe the experiences of education, clinical practice, and supervision of EMDR psychotherapy in the process of obtaining European accreditation of EMDR trainees from Bosnia and Herzegovina. SUBJECTS AND METHODS In order to understand how EMDR trainees perceive the process of supervision up to accreditation, nine questions were sent by email to 95 EMDR trainees about practicing EMDR, the number of patients with whom they use EMDR on a monthly basis, about their supervisors, and the number of completed supervisions, blocks to treatment while practicing EMDR, as well as positive experiences with EMDR practice and working with supervisors. 36 EMDR trainees answered these questions. The answers were analyzed using quantitative and qualitative methods. RESULTS Of the 36 participants in this short study, 30 (83.3%) are women. Most of them are from Sarajevo 14 (38.9%), Tuzla 8 (22.2%) and Mostar 3 (8.3%), 2 (5.6%) from Bihać, Brčko, Gradačac, one from Banovići, Jajce, Prnjavor, Pale and Zenica. Psychologists make up the highest number of participants 25 (72.3%), followed by 5 (13.9) neuropsychiatric specialists. 31 currently have a supervisor (86.1%), 6 have changed their supervisor, and these 31 do not want to change their existing supervisor. Of them, 5 (13.9%) asked to be assigned a new supervisor. A qualitative analysis of the respondents revealed that the greatest problem in practicing EMDR therapy is the lack of space and time in the institutions where they work, the inability to reach patients seeking EMDR treatment, the parallel use of psychotherapeutic guidelines that they have previously adopted, and insufficient determination to use EMDR. They are mostly satisfied with the experience they have gained in supervision which they deem very important in the process of accreditation. They highly appreciate the expertise and accessibility of the supervisors, to whom they are grateful for the help and support they received while presenting their cases from EMDR practice. CONCLUSIONS Findings from this study can serve as a basis for improving the supervisory process during the acquisition of European accreditation for EMDR practitioners in B&H. The findings can also aid in understanding the difficulties mental health professionals in BiH face practicing EMDR therapy while working towards the accreditation as practitioners of this very effective and necessary psychotherapeutic method.

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