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.

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

Introduction Developmental predisposition to schizophrenia can be a consequence of early experienced traumas. Transgenerational trauma is process in which traumatic experience of one generation is passed on to the next generation. Objectives To show connection between transgenerational transmission of trauma and development of schizophrenia. Methods Psychiatric interview, psychological testing. Results Patient G.E. age 29, admitted to Psychiatry Clinic due to altered behavior, aggressiveness and presence of delusions and hallucinations. First mental problems in form of a catatonic stupor appeared 6 years ago. Patient has history of earlier abuse of psychoactive substances. A drug test performed at admission was negative. Patient was born in Srebrenica in 1993, he escaped to Tuzla with his mother in July 1995, while father survived escaping on foot. Patient is a first child from his father’s second marriage. The father’s first wife and two minor children were shot by Bosnian Serbs in early 1992. Patient was born a year and a half after death of his siblings and was named after his half-sister. Patient’s father consumed alcohol after the war and was aggressive towards children. In the last two years, patient had frequent hallucinations, he told his parents that voices were telling him to kill his mother and told his father that his children were still alive. Diagnostic processing was performed and diagnosis of schizophrenia was stated. During hospitalization, patient was treated with olanzapine and low doses of haloperidol, along with haloperidol decanoate, which resulted in significant reduction of productive psychotic symptoms. A partial remission is achieved, negative schizophrenic symptoms and cognitive impairments verified by psychological instruments remain. Conclusions Case report emphasize transgenerational transmission of trauma: father‘s untreated trauma, alcohol dependency and abuse of the patient in childhood. These findings are important for treatment and therapeutic considerations. Mentalizing is a possible mediator between childhood abuse and negative symptoms. Parental bonding was explored within high expressed emotions theory as a risk factor for relapse to psychosis, especially the “affectionless control” in the parental (mainly father‘s) bonding style. Studies also stated that psychotic patients often show insecure attachment representations. Possible pathway for further analysis could be discussed: a cold parental bonding style leading to experienced emotional neglect and attachment avoidance might be reflected in lower capacity to mentalize. To improve the mentalization capacity, it would be essential to establish a sustainable therapeutic treatment frame. 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.

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.

Introduction: Consequences of alcohol dependence may be complex, and difficult for treatment, thus complex diagnostic procedures are needed.Aim: To assess the prevalence of silent brain strokes and cortical cerebral atrophy amongst male inpatient alcoholics.Methodology: We analyzed 86 file records of males treated from 01 January 2005 to 31 December 2009 year on Tuzla Psychiatry Department, who had dismissed diagnosis Alcohol dependency (F 10.2) according ICD-10, with computerized tomography (CT) of brain, related to age, war engagement, brain trauma, employment, smoking, psychological findings and presence of silent stroke and cortical brain atrophy according CT diagnosis.Results: The mean age of observed patients was 50.1±6.6 years. Amongst them (70.9%) were active soldiers in Bosnia-Herzegovina Army during 1992-1995 war. There were 71 (72.6%) with atrophy of brain cortex, 27 (31.4%) had ischemic silent stroke. In the sample, 61 (70.9%) of inpatients met criteria for PTSD according ICD-10, 53 (61.6%) had cognitive disturbances, 29 (33.7%) had psychotic symptoms, 50 (58.1%) of them had clinically manifested depression, 47 (54.7%) had difficulties in social contacts, 23 (26.7%) had somatic disorders. Age of inpatients was in positive correlation with duration of work, presence of silent ischemic stroke and brain cortex atrophy. Presence of PTSD was in positive correlation with involvement in the combatants, with cognitive disturbances, with depressiveness and somatic complains. Atrophy of brain cortex positively correlated with silent stroke and glucose blood level. Conclusion: Brain cortical atrophy and silent brain stroke were frequent CT findings amongst male alcohol dependants clinically treated in Psychiatry department.