Sertraline, paroxetine, and venlafaxine in refugee posttraumatic stress disorder with depression symptoms.

Three new antidepressants were used in treating posttraumatic stress disorder (PTSD) and symptoms of depression in Bosnian refugees. Thirty-two Bosnian refugees seeking treatment at a mental health clinic participated in a case series study. All received open trials of Sertraline (n = 15), Paroxetine (n = 12), or Venlafaxine (n = 5), with standard clinical doses. Overall, Sertraline and Paroxetine produced statistically significant improvement at 6 weeks in PTSD symptom severity in depression, and in Global Assessment of Functioning. Venlafaxine produced improvement in PTSD symptom severity and in Global Assessment of Functioning, did not yield improvement in symptoms of major depressive disorder; and had a high rate of side effects. Notwithstanding improvement of symptoms, all 32 refugees remained PTSD positive at the diagnostic level at the 6-week follow-up.

Sertralilne, paroxetine and venlafaxine in refugee post traumatic stress disorder with depression symptoms.

The authors describe the use of three new antidepressants: Sertralilne, Paroxetine and Venlafaxine in treating Posttraumatic Stress Disorder and symptoms of Depression in adult Bosnian refugees victims of ethnic cleansing. 32 Bosnian refugees with PTSD and symptoms of Depression presenting for treatment of the mental health consequences of surviving ethnic cleansing, participated in a case series study. All subjects completed open trials of Sertraline (15), Paroxetine (12) or Venlafaxine (5), with standard clinical doses. Overall, Sertraline and Paroxetine yielded statistically significant improvement at 6 weeks in the total PTSD symptom severity, in each symptom cluster, in Beck Depression Inventory and in Global Assessment of Functioning. Venlafaxine produced statistically significant improvement at 6 weeks in the total PTSD symptom severity, in each symptom cluster and in Global Assessment of Functioning but did not yield significant improvement in symptoms of depression and had a high rate of side effects.

Discontinuation of SSRI's in traumatized refugees.

OBJECTIVE: To conduct a preliminary study on the discontinuation of SSRI's in a population of traumatized refugees from Bosnia. SUBJECTS: Subjects were the 33 Bosnian refugees being treated in our clinical program who had discontinued SSRI's over a six month period. All had been on SSRI's for over one year and had shown a therapeutic response. The discontinuations were either planned with their clinician or self-initiated. Their age were ranged between 36 and 64, with a means of 56. Ten were men and twenty three were women. Standardized assessments were done approximately 2 months after discontinuation. RESULTS: Upon reassessment after discontinuation, fourteen (43%) met symptom criteria for PTSD. He means PTSD severity rating was 16.0 and the BDI score was 8.5. Seven persons (21%) restarted SSRI's and twenty-six (79%) did not. Statistical analysis showed that the group that restarted differed from the others in terms of lower age, higher PTSD diagnosis and severity, higher BDI score, poorer sleep, and higher subjective with either PTSD or BDI scores. CONCLUSION: This preliminary study suggests that when traumatized refugees discontinue SSRI's, still they have significant PTSD and depressive symptoms, indicating chronicity. The choice of discontinue or restart SSRI's is in part related to symptom severity, but other psychosocial factors appear entering into the equation. There is a need for further research.

Profiling the trauma related symptoms of Bosnian refugees who have not sought mental health services.

The objective of this study was to profile trauma related psychiatric symptoms in a group of refugees not seeking mental health services and to consider the services implications. The study involved research assessments of two groups of Bosnian refugees: those who have not presented for mental health services and those who have. A total of 28 of 41 nonpresenters (70%) met symptom criteria for posttraumatic stress disorder (PTSD) diagnosis. All service presenters (N = 29) met symptom criteria for PTSD diagnosis. The group that did not present for services reported substantial but lower trauma exposure, PTSD symptom severity, and depression symptom severity. They had significant differences on all subscales of the MOS SF-36, indicating better health status. We concluded that those who do not seek services have substantial symptom levels, but their self-concept appears to be less oriented toward illness and help seeking. Innovative access, engagement, and preventive interventions are needed to address those who have symptoms but do not readily seek help for trauma mental health services.

[Effect of the war on developmental lag of medical technology in Bosnia-Herzegovina]. / Posljedice rata na naucno-tehnolosko zaostajanje u medicini Bosne i Hercegovine.

The war in Bosnia and Herzegovina, caused by the aggression of neighbouring countries, besides biological destruction and poverty halted every scientific and technological development in all areas, and in medicine, too. This paper presents vital events in population, forced migrations and violent deaths also. A comparative review and state level of medical technology for particular specialist disciplines in B&H is shown for 1995 and 1990. The criteria for the assessment of lagging in technology and health development is the number and structure of specialized staff, state of premises and medical equipment, bioinformatics, etc, with personal estimation of selected number of leading experts in various medical disciplines (Delfy method) about working conditions. The paper presents the assessment of technological lagging in health sector in B&H (average rate of 40.4%) due to the war, related to 1990.

[Organization of emergency medicine based on the frequency and severity of emergency conditions]. / Organizacija urgentne medicine u svjetlu ucestalosti i tezine urgentnih stanja.

The spontaneous development of the organization and practice of emergency medicine created a number of types of emergency medicine units. Long time, these units were developed in out-hospital institutions such as health centres. Together with these services, all acute hospitals have had full day,s emergency services for definite care of urgent conditions. The authors give principles of this activity organization in the light of expected incidence and severity of urgent conditions related to the number of population which gravitate to particular hospital or other health services. Starting from the assumption that expected frequency of urgent conditions per 100 persons in 24 hours is between 0.50-0.75, the authors present the model of health care organization of such cases including family doctor, health station, health centre, hospital.

[Prevention of bronchial and pulmonary carcinoma]. / Savremene mogucnosti prevencije Ca bronha i pluca.

Malignant neoplasms, and especially CA of bronchi and lungs, are major health and social problem, regard of frequency, as well as duration of treatment, and place among leading causes of death. Among all types of malignant neoplasms, CA of bronchi and lungs correlates directly with tobacco consumption and environmental risk'factors, such as industrial pollutants of the human micro and macro environment. Author presents specific preventive programmes of CA of bronchi and lungs, as well as the evaluation programme of integrated national activities in reduction of malignant neoplasms.