Creative Psychopharmacotherapy in Child and Adolescent Psychiatry and Experiences from Bosnia and Herzegovina.

INTRODUCTION: Paediatric psychopharmacology involves the application of psychotropic agents to the treatment of children and adolescents with mental disorders and gathered knowledge from child and adolescent psychiatry (CAP), neurology, paediatrics and pharmacology. Defining elements of this discipline are: the metabolism of drugs is different in children than in adults (pharmacokinetics), the developing brain reacts specifically to the drug (pharmaco dynamics), and psychopathology itself is not differentiated yet. To make and overview of specifics in psychopharmacological use in CAP and emphasize some experiences from Bosnia and Herzegovina in that field. METHODS: Through insight in current literature, we presented comprehensive findings and compare it with situation in Bosnia and Herzegovina. RESULTS: The most common conditions in which psycho pharmaceuticals are used in CAP were attention deficit hyperactivity disorders (ADHD), depressive and bipolar disorder, obsessive compulsive disorder and the treatment of early psychosis. Psycho pharmaceuticals were also used to treat agitated conditions in various causes. We made an overview of psycho pharmaceuticals use in Bosnia and Herzegovina CAP and emphasized the fact that psycho stimulants are not approved for the use yet, although they are mostly prescribed medicament in CAP over the world. That limits us in the effectiveness of the treatment in ADHD and put us in the situations to use other medicaments instead (anxiolytics, antipsychotics, mood stabilizers) which are not approved for that condition. CONCLUSION: The use of psycho pharmacotherapy in CAP is justified in cases where it is necessary to reduce the suffering of children and to improve their functionality at the time when cognitive, social and emotional advancement is most pronounced. Further research and clinical monitoring of efficacy and safety in the use of psycho pharmaceuticals in youngsters are necessary.

Organization of mental healthcare in Bosnia and Herzegovina during coronavirus disease 2019 pandemic.

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: 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.

Mental Disorders in Sexually Abused Children.

Sexual abuse in childhood is associated with many adverse consequences for survival during their lifetime. Numerous research studies clearly show the link between sexual abuse of children and the spectrum of unfavorable mental, social, sexual, interpersonal and behavioral as well as physical health consequences. Current research shows the strongest link between sexual abuse of children and the presence of depression, alcohol and abuse of other psychoactive substances and nutritional disorders in surviving women and anxiety-related disorders in male survivors. There is also an increased risk of re-victimization, especially for girls. Negative effects of mental health in children with sexual abuse include posttraumatic symptoms, depression, helplessness, negative evaluation, aggressive behavior and behavioral problems. Recent research links sexual assault on children with psychotic disorders, including schizophrenia and dysfunctional disorders, as well as personality disorders. Sexual abuse of children involving penetration is specifically identified as a risk factor for the development of psychotic and schizophrenic symptoms. Many studies have shown that sexual victimization in childhood is a significant risk factor for suicidal ideation and suicidal behaviors.

Changing Diagnostic Category in Development Psychiatry.

INTRODUCTION: Many children and adolescents have mental problems that undermine their normal development and functioning. It is estimated that about 10% of children and adolescents suffer from mental disorders at a sufficiently severe level to cause some degree of damage and require treatment. AIM: The aim of this paper is to determine whether there have been changes in the diagnostic categories in developmental psychiatry in children and adolescents treated at the Department for Children and Adolescent Psychiatry for the last fifteen years. SUBJECTS AND METHODS: The survey includes 844 patients treated at the Department for Child and Adolescent Psychiatry of University Clinical Center of the Republic of Srpska in the period from April 2002 to September 2017, involving only children and adolescents who were hospitalized for the first time. The sample consisted of 453 female subjects (54, 67%) and 391 male subjects (46, 33%). Subjects were divided into three groups: group 1 - hospitalization in the period from 2002 to 2007; group 2 - hospitalization in the period from 2008 to 2012; group 3 - hospitalization in the period from 2013 to September 2017. RESULTS: Female subjects accounted for more than half of the subjects within each group, with a mild increase in the number of patients in the last 4 years. In the overall sample, adolescents, aged 13 to 18 (51.66%) were the most frequent, with the lowest number of subjects under 6 years of age (3.91%). In the overall sample, the most frequent are: psychotic disorders in 18.60% of subjects; behavioral disorders and emotions in 17, 42% of subjects; suicide attempt, in 14.34% of subjects. By comparing data by groups, there has been a decline in psychotic disorders, and since 2008, adapting disorders and behavioral and emotional disorders have been most frequently diagnosed. There is an increase in the number of respondents who come from incomplete families in the last few years. About one-third of the sample (33.89%) were exposed to one or more types of abuse. 43.13% of children and adolescents with poor socio-economic status. Comorbid diseases are present in 5.92% of children and adolescents. In 26.18% of the sample, psychiatric disorders are present in the family history. The abuse of psychoactive substances was observed in 2.61% of adolescents, and this number has been increasing for the last five years. Family dysfunction is present in 57.35% of children and adolescents. CONCLUSION: In our study, there was an increase in the number of children and adolescents with behavioral disorders and adjustment disorders, as well as an increase in family dysfunctionality and psychoactive substances abuse in adolescents.

Comorbidity in children and adolescent psychiatry.

Numerous epidemiological and clinical studies found a high incidence of comorbidity in children and adolescent psychiatry. In population of children and adolescents is most often described and researched comorbidity of depression, anxiety disorders, than in hyperkinetic and behavioral disorders, and finally the difficulty in reading (dyslexia) and antisocial behavior disorders. The common occurrence of two diagnoses may be the result of a disorder that has a complex pattern of symptoms, which apparently seems to be two disorders, but in fact is a single disorder. Comorbidity may be two disorders that share the same set of risk factors or is it possible that a one disorder is a risk of development of other disorder. Knowledge and understanding of comorbidity is important as a preventive and therapeutic point of view. Comorbidity is particularly important because complicates diagnostic process and influences the course, prognosis and treatment of children and adolescents.

Eating behavior disorders of female adolescents.

BACKGROUND: Adolescence is a period of significant physical, emotional and intellectual changes, as well as changes in social roles, relations and expectations. OBJECTIVE: Our objective was to inquire into eating attitudes among female adolescents. SUBJECTS AND METHOD: The sample consisted of female adolescents, age of 16-17, attending first grade Economic and Medical Secondary School pupils in Banja Luka, 2007. Survey questionnaire (16 questions) is a scale for self-rating of eating disorders designed by the author. Response rate was 389 out of 419 (92.8%). RESULTS: Eight point seven per cent of the female adolescents had a Body Mass Index (BMI) less than 18.5. More than half want to be thinner, while 1/3 of adolescents accepted themselves whether thin or obese. Forty-seven percent (47%) of adolescents exercise sometimes, 15.4% exercise often while 1/5 goes on a diet sometimes or regularly. About 43% adolescents are sometimes or often terrified about being overweight, while 60% sometimes or often lose weight. About 2/3 adolescents are not satisfied with their figure. One-half of the adolescents are terrified of increasing their weight. There is a statistically significant relation between female adolescents with, and female adolescents without control in eating, in both schools (p<0.05). DISCUSSION: This research indicates the necessity of education of adolescents and developing prevention programs to help them to adopt healthier nutrition and lifestyle in early life. CONCLUSION: There is a high level of discontent and dissatisfaction with their figure among adolescents. One-third (1/3) of adolescents accept themselves whether thin or obese, while about 43% adolescents are sometimes or often terrified about being overweight. One-half of adolescents are terrified by increase in weight.