Patient Satisfaction with Use of Telemedicine in University Clinic of Psychiatry: Skopje, North Macedonia During COVID-19 Pandemic.

Background: There is increasing interest in the use of telemedicine as a means of health care delivery especially in circumstances of pandemics. This is partly because technological advances have made the equipment less expensive and simpler to use and partly because increasing health care costs and patient expectations have increased the need to find alternative modes of health care delivery. Introduction: Telemedicine and telepsychiatry, in particular, are rapidly becoming important delivery approaches to providing clinical care and information to patients in cases wherein the medical resources and the patients are very hard to be brought together with respect to rules of behavior in case of epidemics. The reliance on technology to bridge the obstacles between the patients (consumers) and medical resources (providers) can create problems that impact service delivery and outcomes, but in cases such as this (COVID-19 pandemics), this is virtually the only tool for providing clinical care and information to patients. Materials and Methods: A client satisfaction survey was undertaken in a daily hospital (a part of University Clinic of Psychiatry in Skopje). The anonymous modified self-report questionnaire (short form patient satisfaction questionnaire [PSQ-18]) covering demographic, gender, and age variables was endorsed by 28 participants. The mean age of the subjects was 40.25 ± 22 years, with a small majority of men (18 participants) versus women (11 participants). Results: Overall satisfaction with psychiatric care was high (80.22%). None of the demographic or other variables correlated significantly with satisfaction. Discussion: We had to reduce rate and time length of our face-to-face contacts with patients as a result of pandemics but they were able to reach their doctors virtually at all times. Conclusions: Many mental health professionals are using widely available, commercial software downloaded from the internet to provide care directly to a patient's home.

Mental Health Legislation and Involuntary Hospitalization in the Republic of Macedonia.

As psychiatrists, we are often obliged to provide non-consensual treatment. This institute comprises the rights of the patients with mental health disorders. The aim of this paper is to explain the contemporary mental health legislation in our country the Republic of Macedonia and the problems with the implementation of involuntary hospitalisation. This could be overcome with close cooperation between the judicial and health care system.

Association between Serum Cortisol and DHEA-S Levels and Response to Antipsychotic Treatment in Schizophrenia.

BACKGROUND: Previous studies suggested that alterations in serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia. AIM: To compare serum cortisol and DHEA-S levels between patients with schizophrenia and healthy controls and to evaluate their association with the response to antipsychotic treatment. MATERIAL AND METHODS: In this clinical prospective study were included 60 patients with schizophrenia and 40 healthy age and sex matched control subjects. Clinical evaluation of patients was performed using the Positive and Negative Symptom Scale. A questionnaire for socio-demographic and clinical data collection was used. For the purposes of the study, the examined group was divided in two subgroups: responders and nonresponders. Serum cortisol and DHEA-S levels were measured at baseline in all participants and after 3 and 6 weeks of the antipsychotic treatment in patients with schizophrenia. RESULTS: Patients with schizophrenia had significantly higher serum cortisol and DHEA-S levels in comparison to the control group. Responders had significantly higher serum cortisol and DHEA-S levels compared with nonresponders. CONCLUSION: Elevated serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia and they may be related to positive response to antipsychotic treatment in patients with schizophrenia.

Different serum BDNF levels in depression: results from BDNF studies in FYR Macedonia and Bulgaria.

BACKGROUND: A growing body of evidence shows that brain-derived neurotrophic factor (BDNF) plays a role in depressive disorder. Serum BDNF levels are lower in depressed patients and they increase after a long course of antidepressant treatment. Our study aims to test the effect of antidepressant treatment on serum BDNF levels in patients with a depressive episode, after they have achieved remission in two studies in Macedonia and Bulgaria. SUBJECTS AND METHODS: In the Macedonian study 23 patients were included (11 female, 12 male) diagnosed with a first depressive episode according to ICD-10, as well as 23 control subjects age- and sex-matched without a history of psychiatric disorder. In the Bulgarian study 10 female patients with depression and 10 control subjects were included. We have applied the Hamilton Depression Rating Scale (HDRS) to assess depression severity. Blood samples were collected before antidepressive treatment and after remission was achieved (decrease to 7 points or less on HDRS). RESULTS: In the Macedonian study, mean serum BDNF level at baseline was 13.15±6.75 ng/ml and the mean HDRS score was 28.52±4.02. Untreated depressed patients showed significantly lower serum BDNF levels compared to the control group (25.95±9.17 ng/ml). After remission was achieved, the mean serum BDNF level was 24.73±11.80 ng/ml whereas the mean HDRS score was 7.04±3.15. After 8 weeks of treatment there was no statistically significant difference in the serum BDNF levels between the two groups. In the Bulgarian study, baseline mean serum BDNF levels were 26.84±8.66 ng/ml, after 3 weeks treatment and remission was achieved mean serum BDNF levels were 30.33±9.25 ng/ml and in the control group mean serum BDNF levels were 25.04±2.88 ng/ml. Integrated results showed baseline mean serum BDNF levels of 17.30±9.66 ng/ml, after achieved remission 26.43±11.25 ng/ml and in the control group mean serum BDNF levels of 25.68±7.76 ng/ml. CONCLUSION: The Bulgarian results showed no statistical difference between the depressed group and controls. The Integrated results and the Macedonian study supported previous findings of low BDNF levels in untreated depressive patients compared to healthy controls, and that those levels increase after antidepressant treatment. These results may suggest that low serum levels of BDNF are a state abnormality that is evident during depression and normalizes during remission.

Forms of antipsychotic therapy: improved individual outcomes under personalised treatment of schizophrenia focused on depression.

Depressive symptoms are common in schizophrenia and they can occur during any phase of the disorder. Early diagnosis, adequate differential diagnosis and promptly initiated interventions have been shown to reduce further deterioration of illness and to improve patients' quality of life. Common psychiatric rating scales for early detection of depressive symptoms in schizophrenia are Calgary Depression Scale for Schizophrenia and Hamilton Depression Rating Scale, but the most appropriate assessment instrument today regarding this topic is Calgary Depression Scale for Schizophrenia. Treatment of depression in schizophrenia consists of a combination of pharmacologic and psychosocial approach. Atypical antipsychotics have advantages over typical in reducing depressive symptoms in the context of schizophrenia. Most of the studies referred that clozapine, olanzapine, quetiapine and risperidone have an antidepressant spectrum of activity in patients with schizophrenia. Antidepressant augmentation of antipsychotic treatment in schizophrenic patients with depressive symptoms improves depressive symptomatology, particularly SSRI and SNRI augmentation.