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Dina Šmigalović, M. Hasanovic, I. Pajević, A. Kurjak, M. Jakovljevič, Aron Mulahalilović

The authors presented a psychopharmacotherapeutic approach to the treatment of women in the prenatal period that requires a personalized, person-centered treatment plan. Treatment should include care for the mental health of women of childbearing age, pregnancy planning, during the prenatal period, and then during the postpartum period. The authors highlighted creative psychopharmacotherapy which is the foundation of holistic and integrative treatment of mental disorders. They emphasize the significant role of the mother in the emotional development of the child, which begins while the child is still in the womb. Mothers who stop taking psychotropic drugs during pregnancy have an increased risk of recurrence of the mental disorder after childbirth because the mother's psychiatric illness is not a benign event and can cause significant morbidity for both the mother and her child, therefore, discontinuation or denial of medication during pregnancy is not always the safest option. For more serious disorders, such as schizophrenia, bipolar disorder, and severe depression, medications may be needed during pregnancy and lactation, despite complex evidence based on the effects of psychotropic medications on the fetus and newborn. Perinatal mental health has become a significant focus of interest in recent years. The randomized controlled examinations provide evidence of the effectiveness of psychological and psychosocial interventions at the individual level. It is necessary to make a new conceptual shift in the approach to maintaining the mental health of pregnant women and newborns, and that is to optimize the mental health of pregnant women, and not simply reduce the symptoms of mental disorders from which they suffer before conception, during pregnancy and after childbirth. Dilemmas and challenges of psychopharmacotherapeutic treatment in the prenatal period are intensified by the knowledge that the psychological difficulties of mothers can significantly affect the integrity of the safe relationship between mother and child, which is essential for the emotional, cognitive, and behavioral development of the child. Often, these problems existed before pregnancy or occurred during pregnancy, and they are often the deterioration of the mental state due to discontinuation of pharmacotherapy during this period. The quality of the biopsychosocial milieu in the fetal period and childhood during the early neuroplastic development phase is one of the determinants of risk for diseases during the life cycle. For this reason, the mental health of pregnant women and mothers must be optimized. For many of these women, health is optimized with pharmacotherapy.

Anel Brigić, M. Hasanovic, I. Pajević, N. Aljukić, J. Hamidović, M. Jakovljevič

In this paper authors described some of the principles and theses of Hippocratic medicine. They emphasized that regardless existing controversial opinions as to whether Hippocrates stated some theses or not, and controversial views on some of his principles, he is often called the "father" of medicine, who laid the foundations in medicine as a science. Hippocrates gave recommendations on the doctor's behavior towards the patient, which is relevant up today. His holistic approach to medicine is becoming more and more relevant in the modern medicine. The application of the Hippocratic Oath today depends on the legislation of individual states, related to how legal solutions in some states are pro or contra to it. Authors opened and discussed his attitudes that mental illnesses are a sign of a diseased brain, his consideration the food as medicine and that the disease came from the intestines. Also issue of prognosis of the disease was opened and discussed as well as and Hippocrates's consideration of work and physical activity as the most appropriate medicine. Furthermore, authors considered importance of Hippocratic medicine related to Creative psychopharmacotherapy based on therapeutic communication and the creative satisfaction of needs in the therapeutic relationship with patients and in the recovery itself. Finally, an example of creatively use of the principle of Hippocratic medicine: "work as the most appropriate medicine" in therapeutic communication with patients through an ecological approach called "Ecopsychiatry", under the slogan presented in the media to the general public: "Cleansing nature improves your mental health" was described.

M. Mešanović, I. Pajević, M. Hasanovic

INTRODUCTION Previous research has shown the simultaneous presence of health diseases and alcohol use disorder (AUD). This research emphasizes the importance of individual diseases, the simultaneous presence and connection of different diseases, which creates the conditions for more adequate treatment of patients with AUD. Determine somatic, neurological and psychiatric diseases in patients with AUD in the Tuzla Canton (TK) in the period from 01.01.2011. to 31.12.2015. SUBJECTS AND METHODS A retrospective study on the systematic cause of 1,863 patients with AUD recorded in the TK health system. RESULTS Among 1004 (53.9%) patients with AUD, somatic diseases were present; in men: arterial hypertension 573 (31.7%), alcoholic liver disease 269 (14.9%), diabetes mellitus 211 (11.7%); and in women: arterial hypertension 27 (49.1%), diabetes mellitus 27 (49.1%), elevated lipoproteins 3 (5.5%); alcoholic liver disease 1 (1.8%) and anemia 1 (1.8%). Among 1196 (64,2%) patients with AUD, neurological diseases were present; in men: cognitive impairment 627 (34.7%), post-stroke condition 418 (23.1%), polyneuropathy 269 (14.9%); and in women, post stroke condition 28 (50.9%). Psychiatric comorbidity was determined in 1619 (86.9%) patients with AUD; in men: depressive disorder 806 (44.6%), personality disorder 660 (36.5%), while nicotine addiction 27 (1.5%) and dementia 13 (0.7%) were least present; in women: personality disorder 33 (60.0%), neurotic disorder 27 (49.1%), depressive disorder 22 (40.0%). The largest number of patients with somatic (787 or 42.25%), neurological (939 or 50.40%) and psychiatric comorbidity (939 or 50.40%) belonged to the age group 55-64.9 years. CONCLUSION Slightly more than half of the patients with AUD were diagnosed with somatic diseases, almost two thirds were diagnosed with neurological diseases and with more than four fifths of patients were diagnosed with psychiatric diseases. Of the somatic diseases the most common ones were, arterial hypertension, diabetes mellitus, and alcoholic liver disease; from neurological diseases: cognitive impairment, post-stroke condition and polyneuropathy; and the most common of psychiatric illnesses were depressive disorder and personality disorder. The largest number of patients are in the ages of 55-64.9.

I. Pajević, M. Hasanovic, N. Žigić, Ahmed Pajević, L. Avdić

BACKGROUNDS Written historical evidence reveals that Cannabis sativa has been used medically, recreationally and spiritually for more than five centuries in many cultures. It is considered the most-used plant-based psychoactive substance with millions of different usages across the world. To review what the studies, conducted over the past two decades, indicate about effects of the cannabis on physical and mental health as well as the impact on social functioning. METHODS We selected literature review using PubMed resources, to summarize the findings of the existing publications on cannabis and cannabinoids and their possible psychopharmacological therapeutic effects only. RESULTS Research supports cannabis' clear acute effect on neurocognition, while non-acute effects for prolonged use of marijuana are unclear and still insufficiently explored. Due to cannabidiol's (CBD) safety and tolerability, the absence of psychoactive or cognitive effects, the existence of clinical trials with positive results and its broad pharmacological spectrum, CBD is a cannabinoid whose initial results will likely lead to implementation into clinical practice. The fact that the results of previous studies establish the claim of CBD as an antipsychotic and anxiolytic, makes the above developments even more likely. However, long-term, double-blind, placebo studies with samples of patients with different psychotic and anxiety disorders are still necessary. Likewise, due to CBD's biphasic effects, determining an adequate therapeutic dose remains a challenge to conclude, the cannabinoid system represents a promising target for new therapeutic interventions in psychiatry. CONCLUSION Further controlled studies are essential to determine the precise mechanisms of action of cannabinoids on various neuropsychiatric disorders as well as the safety of their use are needed. Never just the use of 'smoking cannabis in an unlicenced way'. The use of simple 'smoked cannabis' remains dangerous because of the effects on inducing psychosis which the article itself refers to, and needs to remain illegal.

J. Hamidović, M. Hasanovic, I. Pajević, L. Dostović Hamidović, M. Jakovljevič

It is well known that emotions have always attracted the special attention of both laymen and scientists because life without emotions is unthinkable. Emotions prepare us for all life circumstances regardless of their qualities and intensities. Reviewing the available literature, the authors described the phenomenon of emotional contamination and its importance in interpersonal relationships with a focus on "infecting" other people's emotions. Research has shown that individuals mimic facial expressions as well as other emotional reactions of others by emotional contamination in interaction with another person manifesting emotional behavior, and in such situations mimic model reactions, with the perception of their own reactions eliciting an appropriate emotional state. They stressed the importance of patient's perceptions of the emotions of the physicians treating them and the caring attitude that is crucial to contributing to treatment outcomes in clinical practice. Specific expectations between the patient and his physician, when they meet and achieve a physician-patient relationship, reduce uncertainty, and play a useful and crucial role in healing. A caring emotional practitioner who can effectively connect with patients is a huge boon to health. The connection of emotional contamination with creative psychopharmacotherapy and with several therapeutic options is especially described, determined in different ways either through narrative psychopharmacotherapy, through assertive and positive communication, creating a favorable and positive therapeutic relationship whereby a partnership is created, which together leads to the main goal, which is the successful treatment of the patient to the mutual satisfaction. It is useful for patients to have a doctor who spends more time with them and listens carefully and, with adequate emotions, strongly and effectively facilitates treatment. They conclude that emotional contamination is a phenomenon that happens every day in life, especially in specific situations, and that it is up to professionals to use this type of therapeutic opportunity and assistance in the right way to help their patients and be creative in a psychopharmacotherapeutic sense.

N. Žigić, M. Hasanovic, I. Pajević, M. Jakovljevič

BACKGROUND Indian hemp (lat. Cannabis sativa subs. Indica) has been used as a source of industrial fiber, seed oil, food, medicine for some somatic diseases, and it is also used as a psychoactive substance. Cannabis can be used by smoking, evaporation, as a food ingredient, or as an extract. Acute and chronic cannabis use has been shown to be detrimental to several aspects of psychological and physical health and many experimental studies done on healthy people indicate the potential of Δ9- tetra hydro cannabinoid (THC) in inducing transient, dose-dependent psychotic symptoms, but also affective, behavioral, cognitive, neurovegetative, and psychophysical symptoms. Cannabis is the most commonly used illegal drug globally. In many communities, cannabis is perceived as a low-risk drug, leading to political lobbying to decriminalize its use. The wave of laws and initiatives to liberalize cannabis use continues to spread across the United States and the rest of the world, and there seems to be a political debate in the background about the potential risks and benefits of cannabis use. Aim is to present the possible consequences that the legalization of cannabis would have from the aspect of mental health and mental disorders. METHODS Authors reviewed the literature using PubMed resources on the effects of cannabis using the keywords: cannabis use, cannabis use and psychoticism, cannabis use and depression, cannabis use and anxiety, cannabis use and cognition, cannabis use and insomnia, legalization of cannabis. RESULTS Authors examined the effects of cannabis use on psychiatric disorders and the review of the legal status of cannabis use in the world was also made. The possible consequences of cannabis legalization on the public health system were also considered, based on experiences from countries where legalization has already been done. The evidence cited in this article suggests that strong claims about the need to legalize cannabis are still questionable, and may, even in the long run, remain mixed, inconclusive, or even contradictory. Political interference in this issue can trigger a wide range of unintended but profound and lasting consequences for the health system and the health of the individual. CONCLUSION We recommend further research on this topic and data collection with an emphasis on the effects and consequences of cannabis use on mental health, and in particular the benefits and harmful effects of medical cannabis use.

M. Hasanovic, A. Kuldija, I. Pajević, M. Jakovljevič, Muhammed Hasanović

Addiction does not mean "addiction to substances" only. At the core of the definition of substance dependence is the loss of control. Gambling addiction belongs to non-substance / non-chemical addictions or behavioral/behavioral addictions. The concept of behavioral addictions is new and revolutionary in psychiatry. Gambling addiction, formerly pathological or problematic gambling occurs due to loss of control over gambling. There is growing evidence to suggest that behavioral addictions resemble substance addictions in many domains, including phenomenology, tolerance, comorbidity, overlapping genetic contribution, neurobiological mechanisms, and response to treatment. Behavioral addiction has been proposed as a new class in the Diagnostic Statistical Manual Fifth Revision (DSM-5), but the only category included is gambling addiction. The prevalence of gambling disorders in adolescence is very high and for certain disorders (especially related to the use of the Internet) it becomes more pronounced over time. In this paper, we presented a comprehensive overview of gambling disorders from definition, epidemiology, manifestations, comorbidities, assessment, treatment options, and existing forms of treatment. Given the complexity of the approach to the treatment of gamblers, a creative individualized integrative approach is necessary, which is the basis of creative psychopharmacotherapy. Due to the possibility of the emergence of problem gambling and other impulse-control deficits we need to be very careful when commencing a patient on dopamine replacement therapy or therapy with aripiprazole.

Ahmed Pajević, I. Pajević, M. Jakovljevič, M. Hasanovic, N. Kravić, N. Žigić

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 review of his contributions to medicine, especially to psychiatry. 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 as well as the role of psyche in etiology of somatic diseases. He also describes certain psychiatric diseases along with the explanation of their etiology and recommended therapy. 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.

Vildana Aziraj-Smajić, M. Hasanovic

BACKGROUND The results of the previous research imply that persons with post-traumatic stress disorder (PTSD) are at an increased suicide risk. Suicidality is more probable when PTSD occurs in comorbidity with other psychological disorders. The studying of potential differences and the fundamental social and physiological characteristics of suicidal and non-suicidal persons with PTSD has so far failed to produce consistent results. The objective of this article is to examine whether suicidal and non-suicidal persons with PTSD differ by demographic characteristics, the presence and the type of comorbidity with other psychological disorders and the type of traumatic experience. SUBJECTS AND METHODS The study included 147 participants from Bosnia and Herzegovina, 91 men and 56 women, who have been diagnosed with PTSD under the 10th revision of the International Classification of Diseases (ICD-10). Based on the suicidality status (suicidal/non-suicidal), the sample was divided into two sub-samples. For the purpose of data collection, a clinical interview and a socio-demographic questionnaire was applied during psychological clinical assessment at a psychiatric ward. RESULTS It has been established that suicidal and non-suicidal persons with PTSD differ by demographic characteristics, such as the educational and employment status, the presence of a history of suicide in the family, the presence and type of comorbidity with other psychiatric disorders, and the type of traumatic experience. In terms of age, gender, marital status and psychiatric heredity, no significant differences have been found relative to the suicidality status. CONCLUSIONS Suicidal persons with PTSD more frequently have low education, they are unemployed and have a history of suicide in the family, and they are diagnosed with comorbid psychiatric disorders, dominated by mood disorders and personality disorders, with multiple comorbid disorders combined, and with war, civilian and mixed trauma being equally present in these persons. Based on the established demographic and clinical characteristics of suicidal patients with PTSD, it is possible to improve the psychological and psychiatric assessment of suicidality in persons with PTSD, which enables adequate and timely identification of the suicide risk in this population.

M. Hasanovic, Dina Šmigalović, Magbula Fazlović

The use of violence and aggression on civilians during the war has become one of the most prominent military events of the 20th and 21st centuries, resulting in an increasing number of refugees and displaced persons in the midst of regional and tribal conflicts. We are witnessing a daily increase in the number of migrants when people are fleeing from their homes because of human rights violations, persecution, poverty, and conflict. When found in "host" countries, they often encounter bad conditions, with uncertainty and instability. Many come to Europe in search of economic and personal opportunities for progress, where they face different types of process of acculturation. 'Place loss', acute and chronic trauma, family disorders, and family reunification issues became more and more important issues. Refugees, asylum seekers and irregular migrants have a higher risk for certain mental health disorders, including posttraumatic stress, depression and psychosis. In addition to being exposed to various risk factors for mental disorders, migrants often face barriers to access to adequate health care to address these issues. Some of the biggest challenges for migrant populations within "host" countries include: lack of knowledge of health care rights and health systems; poor knowledge of the language; different belief systems and cultural expectations of health care; and the general lack of trust in experts and in government. The rates of depressive and anxiety disorders usually increase over time, and poor mental health is associated with poor socioeconomic conditions - particularly with social isolation and unemployment. Acculturative stress often implies a high discrepancy in the acculturation between parents and their children. This dislocation of families in new conditions has been caused by the different degrees of acceptance of "new culture" by children and parents, which causes serious difficulties, especially in bilingual terms.

M. Mešanović, I. Pajević, M. Hasanovic, D. Babic

BACKGROUND Researches to date had indicated that socioeconomic status is a strong predictor of health behavior but also it has two-way effect with alcohol use disorder. This study examines social factors and their impact on alcohol use disorder and places individual alcohol use in the context of the status and conditions in which people live. To determine the distribution and characteristics of social factor in patients with alcohol use disorder (AUD) in the area of the Tuzla Canton (TC) in the period 01.01.2011 - 31.12.2015, in relation to: age, sex, marital status, level of education, municipality of residence, home ownership status, family structure, employment status, and monthly monetary income. SUBJECTS AND METHODS Retrospective research was conducted using a systematic sample of 1863 patients with AUD, using documentation from the Psychiatry clinic of the University Clinical Centre (UCC) and the protocols of Health Centres. RESULTS The sample was composed 1808 (97.05%) men and 55 (2.95%) women; the ratio of men to women was 33:1. the ages of the patients in the sample were 54.4±9.79 years - men 54.49±9.74 years; women 51.45±10.94 years. Most of the men in the sample were married (71.1%) and most of the women were widowed (54.5%). The largest number of patients had elementary school education (66.5%), were unemployed (56.8%), with a monthly monetary income less than 300 convertible marks (KM) (62.2%), owned their own home (78.2%), and 36.1% of them lived with a partner or their own children. CONCLUSIONS There are significantly more men being treated for AUD; most of them are married, and most of the women are widowed. The largest number of patients treated for AUD have elementary school education, are unemployed, have monthly monetary income less than 300 km, own their own house, and a little more than one third of them lived with their partner or their own children.

I. Pajević, M. Hasanovic, E. Avdibegović, A. Dzubur-Kulenovic, M. Burgic-Radmanovic, D. Babic, N. Mehić-Basara, N. Zivlak-Radulovic et al.

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.

M. Mešanović, I. Pajević, M. Hasanovic, D. Babic

The different personalities of alcoholics are expressed in the way they manifest certain traits of their personality. In addition to knowing the general and common characteristics of alcoholics, it is even more important for clinical practice to know the differences between them, thus allowing a personalized approach to each patient, as a unique personality. The division of the personalities of alcoholics may be viewed through the prism of seven perspectives: the disease perspective, the dimensional perspective, the cognitive-anxiety perspective, the behavioral perspective, the spiritual/transcendent perspective, the narrative and the systemic perspective. Each of these perspectives more clearly represents part of the personality of the alcoholic; together they give a clearer picture of the problem and accordingly offer different treatment options.

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