Treatment of addicts in Bosnia and Herzegovina--constraints and opportunities.

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.

The organisation of mental health services in post-war Bosnia and Herzegovina.

Bosnia and Herzegovina (BH) is located on the western part of the Balkan Peninsula. It has an area of 51 210 km2 and a population of 3 972 000. According to the Dayton Agreement of November 1995, which ended the 1992-95 war, BH comprises two 'entities' - the Federation of Bosnia and Herzegovina (FBH) and the Republic of Srpska (RS) - and the District of Brcko. The administrative arrangements for the management and financing of mental health services reflect this. The FBH, with 2 325 018 residents, is a federation of 10 cantons, which have equal rights and responsibilities. The RS has 1 487 785 residents and, in contrast, a centralised administration. Brcko District has just under 80 000 residents.

Regional collaboration in reconstruction of mental health services in Bosnia and Herzegovina.

The war in the former Yugoslavia between 1991 and 1995 destroyed the mainly hospital-based mental health care system in Bosnia and Herzegovina. This report summarizes the situation before and after the war and describes efforts to rebuild and reform mental health services under politically and economically challenging conditions. As a result of these efforts, there are now 39 multidisciplinary community mental health centers that are linked to primary care and that aim to provide prevention, treatment, and rehabilitation of mental disorders. The reform process has been supported by international initiatives and is now continuing in collaboration with other countries in South Eastern Europe.

Some historical remarks and current state of mental health services in bosnia and herzegovina.

In this paper we have presented historical overview of development of psychiatric services in Bosnia and Herzegovina. Special attention was given to the recent war destruction (l992-l995), as well as to the reconstruction and reform of mental health services within a frame of newly introduced mental health strategy.

[Characteristics of the dangerous and harmful use of alcohol and psychoactive drugs in Bosnia and Herzegovina in the postwar period]. / Karakteristike opasne i stetne upotrebe aklohola i psihoaktivnih droga u Bosni i Hercegovini u poslijeratnom periodu.

Problems related to abuse of various psychoactive substances started in Bosnia and Herzegovina during the early eighties of the twentieth century. This is proven by the data from Counseling for the prevention and treatment of drug addiction that was working since 1978 until 1992 at the Psychiatric Clinic of the Clinical Center of Sarajevo University. At the end of 1991 this center registered 1000 drug users among which 50 was heroin addicts on the Methadone maintenance treatment. All organized activities on prevention and treatment of drug addiction stop during the spring of 1992. During the war 1992-1995, only few cases of drug addicts was treated due to overdose, abstinence and toxic psychotic states. Catastrophic war devastation had the consequence in social and economic disorganization of the whole society in Bosnia and Herzegovina. Large part of the population was killed or severely wounded. Majority of civilian population were expelled from their homes and spread all over the country and the whole world. Violence toward themselves and others, aggressively, tension, and domestic violence with large number of stress related mental disorders are still characteristics of our society. One of the important features of such a society is incensement of drug abuse, starting with alcohol, tobacco and all sorts of drugs. Extent of this socio-pathological problem are unknown, but indicators such as quantity of confiscated drug, number of legal processes related to drug, number of those who are coming to health institutions due to drug related problems, number of overdoses, and occasional surveys among youth indicated that the problem became more serious than anybody in this society wants to believe. All these indicators are showing that the problem of harmful alcohol, tobacco and drug use in our society have multiple negative consequences, and that in the recent future we cannot expect that these trends will became positive. Obviously, without the support from the community in this area we cannot achieve some good results. Today it is clear that without a strategy and preventive programs for the prevention of alcohol, tobacco and drug use at the state and even regional level there cannot be any success in stopping the epidemy of use and abuse of legal and illicit psychoactive substances.

Frequency of the antipsychotic therapy acute side effects in the treatment of acute psychosis.

Antipsychotic drugs produce a wide spectrum of physiological actions. Some of these effects differ among the various classes of antipsychotics. This medications have indications in the treatment of acute psychotic disorders. The main goal of this investigation was to determine the incidence and prevalence of the neuroleptic therapy acute side effects. The reason for this epidemiological investigation performing was the lack of knowledge of the exact neuroleptic therapy side effects incidence. Qualitative study on this problem has not been performed yet. Antipsychotic therapy side effects prevalence rate according to the literature data is ranging from 24% to 74%. Different prevalence rate is a consequence of different antipsychotic drug usage, different drug administration method and different side effects identification. On account of all these facts, we put the hypothesis on the correlation between the antipsychotic therapy and occurred side effects. Our experiment included all patients hospitalised from December 31st 1999 to January 31st 2000 in Intensive Care Unit of Biological Psychiatry Department of Psychiatric Clinic in Sarajevo. All patients were divided in three groups according to the applied therapy. All of them met ICD-10 criteria for schizophrenia (F20-29). During our study the following examinations were performed: psychiatric interview, BRPS, scale of side effects, psychophysiological tests, general clinical impression, scale of appetite, carbon hydrate needs scale. Psychiatric and statistical evaluations were done as well. The evaluation of our examination is showing successful results in all groups of patients. The improvement of psychopathological symptoms was insignificant. Reported side effects were minimal with low incidence rate and relatively high prevalence rate. Statistical tests were calculated from the obtained data after what the null hypothesis was rejected. Consequently, an alternative hypothesis was confirmed and it indicated that the acute side effects incidence and prevalence were within the range of expectation. Intensity of the recorded side effects was moderate to mild. On the basis of the obtained data, it has been concluded that applied antipsychotic agents did not induce more psychophysiological function impairments in the treated patients. Psychophysiological functions remained in physiological range limits and their changes were not significant. Neuroleptic therapy side effects were minimal, meaning no toxic signs or therapy discontinuations were recorded.

[Abuse of psychoactive substances by adolescents in rural and urban environments]. / Zloupotreba psihoaktivnih supstanci kod adolescenata u ruralnoj i urbanoj sredini.

It is well known that drug abuse is common in early adolescence with almost the same epidemiological characteristics in economical developed and undeveloped countries. Aim of this study is to compare drug abuse among adolescents in the urban and rural areas. Research covers 600 adolescents equal gender and age distribution. Distribution of participants regarding to the rural and urban type of areas, was equal, as well. It was used Q 2000 questionnaires, which was comprehensive tool for all aspects of adolescents life. Results shows that drug abuse is much more common in urban areas (alcohol 62.4%; and cannabis 70.0%; in rural areas alcohol 37.6%; and cannabis 30.0%). Regarding to age, drug abuse is the most common among adolescents aged 15-17. Alcohol is much more related to boys, but regarding to cannabis there is almost no differences.