Posttraumatic Stress Disorder (PTSD) can develop after experiencing or witnessing any severe traumatic event such as combat. Point prevalence rates in war-affected regions, e.g. Bosnia-Herzegovina and Kosovo, range from 18% to 35%. Noradrenergic dysfunction as represented by e.g. elevated noradrenaline concentrations in the cerebrospinal fluid of PTSD patients is known to play a substantial role in the pathogenesis of PTSD symptoms [1]. Epigenetic regulation (i.e. DNA methylation) is strongly suggested to moderate the interaction between environmental influences and a genetic predisposition. Therefore, differential methylation of genes involved in the noradrenergic system such as the monoamine oxidase A (MAOA) gene might be part of the complex biological underpinnings of a dysregulated noradrenergic system and thereby contribute to PTSD risk. The present study aimed at investigating MAOA gene methylation as a possible epigenetic marker of PTSD status and severity in a sample comprising patients with PTSD and healthy controls recruited from war-affected regions in Bosnia-Herzegovina, Croatia and Kosovo. DNA methylation levels of MAOA (exonI/intronI region) were analyzed in PTSD patients [N=216; m=157, age (mean±s.d.): 50.08±6.74 years], remitted PTSD patients [N=151; m=98, age (mean±s.d.): 49.48±8.20 years] and healthy controls [N=349, m=232, age (mean±s.d.): 48.81±8.50 years] by direct sequencing of sodium bisulfite-treated DNA followed by semi-quantitative analysis of the sequencing results via the Epigenetic Sequencing Methylation software. Severity of PTSD symptoms was assessed by the Clinician-Administered PTSD Scale (CAPS). All participants were assessed for potential confounders of methylation (sex, age, or smoking status). Possible categorical differences were analyzed by (M)ANCOVAs with age and smoking status as covariates. Post-hoc tests (Bonferroni) were performed to test individual differences in methylation across groups. Associations between dimensional measures were analyzed performing partial correlation analyses controlled for age and smoking status. In the male subsample, analyses revealed significant methylation differences at three out of 13 CpG sites between patients with current PTSD, remitted PTSD patients, and healthy controls. Post-hoc tests showed trend-wise significant (padjusted<0.1) to significant (padjusted<0.05) hypermethylation in current PTSD patients when compared to healthy controls at CpG3 (padjusted=0.089), CpG12 (padjusted=0.011) and CpG13 (padjusted=0.086) as well as at CpG3 (padjusted=0.029), CpG12 (padjusted<0.001), and CpG13 (padjusted=0.058) when compared to remitted PTSD patients. Additionally, PTSD symptom severity (total CAPS scores) was positively correlated with average MAOA methylation (r=0.206, p=0.016), methylation at CpG3 (r=0.186, p=0.033), CpG12 (r=0.306, p<0.001), and CpG13 (r=0.277, p=0.001) in male patients with a current PTSD diagnosis. In the female subsample, we failed to observe association of MAOA methylation with either current or remitted PTSD, while there was a positive correlation between MAOA methylation and symptom severity (r=0.294, p=0.033). The results of the present study for the first time suggest MAOA hypermethylation – possibly resulting in an increased noradrenergic tonus – as a disease status and severity marker of PTSD particularly in male patients. Given robust replication, MAOA hypermethylation might thus serve as an epigenetic marker within the complex risk factor constellation of PTSD. Furthermore, applying a personalized pharmaco-therapeutic approach, anti-adrenergic agents might prove to be beneficial in counterbalancing increased noradrenergic signalling specifically in male PTSD patients displaying MAOA hypermethylation.

Females who lost tzheir husbands during the war sufer from the different psychic problems. to investigate the association of severity of traumatization and level of somatization, obsessive-compulsive symptoms, sensibility, depressiveness, anxiety, hostility, phobic, paranoia, psychotic symptoms of the females who lost husbands during the 1992-1995 war in Bosnia-Herzegovina (BH). The sample was consisted from 50 females who lost and 50 females who did not lost their husbands in the BH war 1992-1995, of age from 35-60 years. We used The Harvard Trauma Questionnaire and Brief Symptoms Inventory. The obtained results indicate that the level of traumatization was significantely positively associated with the level of the somatization (Pearson's 'r"=0,682; P<0,001), obsessive-compulsive symptoms (r=0,759; P<0,001), sensibility (r=0,698; P<0,001), depressiveness (r=0,743; P<0,001), anxiety (r=0,780; P<0,001), hostility (r=0, 765; P<0,001), phobic (r=0,605; P<0,001), paranoia (r=0,678; P<0,001), and psychotic symptoms (r=0,622; P<0,001) of tested females in the postwar BH. The severity of traumatization of the females who experienced the loss of their husbands during the war 1992.-1995 in Bosnia-Herzegovina significantly positively associated with the level of the somatization, obsessive-compulsive symptoms, sensibility, depressiveness, anxiety, hostility, phobic, paranoia, psychotic symptoms.

Aim The primary objective will focus the first of all on Group Analysis (GA) as the psychotherapy method and theory of group analysis applied particularly in post-war environments. It outlines in particular a Zagreb Institute for GA Training Programme that took place in Tuzla University Clinical Centre, Department of Psychiatry, in Bosnia-Herzegovina (BH) in response to 1992–1995 war, in helping to train mental health workers in GA to enable them to treat psychological trauma symptoms of war survivors. Method In the GA education in the period of 16 years mental health professionals employed in mental health services were involved as well as other care employees as General Practitioners, Family physicians, pediatricians, gynecologists and neurosurgeons, psychologists and special educators. Results Trainees in education were from greater part of BH, and from several towns from neighborhoods countries. In this way a new room for mutual exchanges of experiences and establishing of cooperation was created. Idea of group analytic treatment of persons with mental health problems spread out on the whole region of BH through this model of education. The future of GA application as a psychotherapy model in BH confirmed through established models of education which are employed inowadays in Tuzla, Sarajevo and Mostar. The future of GA is provided in activities focused on foundations of the Institute for Analysis in Tuzla. Conclusion Training of Bosnia-Herzegovina mental health workers to effectively use GA with enthusiastic help of GA trainers from Institute for GA Zagreb will develop dialogue culture in postwar BH.

The primary objective will focus the first of all on Group Analysis (GA) as the psychotherapy method and theory of group analysis applied particularly in post-war environments. It outlines in particular a Zagreb Institute for GA Training Programme that took place in Tuzla University Clinical Centre, Department of Psychiatry, in Bosnia-Herzegovina (BH) in response to 1992–1995 war, in helping to train mental health workers in GA to enable them to treat psychological trauma symptoms of war survivors. Authors described educational process considering the history of idea and its realization through training levels and process of supervision which was provided from the Institute for GA, Department for Psychology Medicine, School of Medicine in University of Zagreb, Croatia in sharing skills of GA to mental health therapists in BH. Highly dedicated internationally approved trainers from GA provided completed training for trainees: neuro- psychiatrists, residents, nurses, psychologists, social workers, special educators, paediatrician, and gynaecologist from several different institutions from seven different cities in BH and Croatia. Training started during the war period with introduction course and continues with Diploma Courses. To be accredited GA therapists all trainees are obliged to practice GA therapy with clients under the supervision process of GA supervisors. Nowadays there are 7 graduated Group Analysts in BH. Three of them are in process of training for educators. Training of Bosnia-Herzegovina mental health workers to effectively use GA with enthusiastic help of GA trainers from Institute for GA Zagreb will increase psychotherapy capacities in postwar BH.

The primary objective will focus the first of all on Eye Movement Reprocessing and Desensitization (EMDR) as an evidence based intervention in the treatment of psycho-traumatized individuals. Its effectiveness has been validated by extensive research. It outlines in particular an EMDR Humanitarian Assistance Training Programme that took place in Tuzla University Clinical Centre, Department of Psychiatry, in Bosnia-Herzegovina (BH) in response to 1992–1995 war, in helping to train mental health workers in EMDR to enable them to treat psychological trauma symptoms of war survivors. Authors described educational process considering the history of idea and its realization through training levels and process of supervision which was provided from the Humanitarian Assistance Program (HAP) of UK &Ireland with non profit, humanitarian approach in sharing skills of EMDR to mental health therapists in BH. Highly dedicated internationally approved trainers from HAP UK & Ireland provided completed EMDR training for 19 trainees: neuro- psychiatrists, residents of neuro-psychiatry and psychologists from eight different health institutions from six different cities in BH. Training started with 24 trainees, but five of them were prevented to complete training. To be accredited EMDR therapists all trainees are obliged to practice EMDR therapy with clients under the supervision process of HAP UK & Ireland supervisors. Because of physical distance between supervisors and trainees, supervision is organized via Skype Internet technology. Training of Bosnia-Herzegovina mental health workers to effectively use EMDR with enthusiastic help of EMDR trainers from HAP UK&Ireland will increase psychotherapy capacities in postwar BH.

IntroductionAdolescents often experience their addictive experiences hidden from parents. Treatment begins when problems arise that adolescents cannt solve it alone.AimTo asses correlation between duration of silence about heroin addiction experience and certain epidemiological data collected with the Pompidou form.MethodsThe authors analyzed the group of 77 heroin addicts aged 26.4 ± 5.6 years, who were treated at the Department of Psychiatry Tuzla in the period 2006–2009 year. Pompidou standardized form was used for collecting the necessary data.ResultsWe found that the heroin addicts began to take the first drug of 17.2 ± 3.9 years, parents were informed about it 2.8 ± 1.3 years later. The duration of silence was positively associated with age of addicts (ρ = 0515, P > 0.001), length of addictive experience (ρ = 0463, P < 0.001), parent's divorce (ρ = 0432, P < 0.001), previous conflict with law (ρ = 0255, P = 0.028), powerty in the family (ρ = 0236, P = 0.045) and previous treatment (ρ = 0354, P = 0.002). On the other hand, it was negatively associated with living in community with other addicts (ρ = -0 363, P = 0.001), intravenous heroin use (ρ = -0 345, P = 0.003), detected hepatitis B (ρ = -0 262, P = 0.002), owning their own children (ρ = -0.280, P = 0.016) and with years of completed education of father (ρ = -0 245, P = 0.008) and of mother (ρ = -0 246, P = 0.036).ConclusionSilence about heroin addiction was positively associated with age of addicts, duration of addiction, parent's divorce, with trouble with law, with poverty in family, and previous treatment. Silence is negatively associated with living with other addicts, intravenous use, hepatitis B, owning children, and more years of parent's completed education.

IntroductionConsequences of alcohol dependence may be complex, and difficult for treatment, thus complex diagnostic procedures are needed.AimTo assess the prevalence of silent brain strokes and cortical cerebral atrophy amongst male inpatient alcoholics.MethodologyWe 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.ResultsThe 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.ConclusionBrain cortical atrophy and silent brain stroke were frequent CT findings amongst male alcohol dependants clinically treated in Psychiatry department.

ObjectiveWe wanted to show how the family secret of adoption can influence even second generation of members.Case studyGirl 15 years of age, high school first grade lived in complete family with older brother and younger sister. Father was a rigid structure, difficult in communication with other family members except youngest daughter. For a first check up she had come with her mother (previously psychiatry treated of depression). Girl was very depressed (CDI 24), her appearance expressed hopelessness, repeatedly thought about suicide, did not accomplish anything she wanted, to study for nurse, or an actress. Two years ago looking through some papers, she had find out that her mother was adopted as a baby, that changed her all life, relationship toward grandparents, could not study, focus on anything else. Just a few days ago she admitted to her mother that she knows a secret about her origins. Her mother also find out that she was adopted when she was 14 (the same age when her daughter find it out), some girls in the school told that to her. Finding out the truth was very devastating for her too.ConclusionTrans - generational transfer of family secret came to resonance of unconscious and girl find out the truth almost in the same age as mother. It has had stressful effect, but also influence trust, and cause anger and feeling of exclusion. Silence has aggressive except protective function. Adolescence as vulnerable developmental age made this girl more sensitive for this.

ObjectivesIn our mind as well as in our body and nature nothing is happened accidentally, we can often see that there is mutual connection between them. There is a case presentation of young man age 29 with obsessive thoughts for getting fatal disease if step on junky needles which he had seen in his neighbor. It thoughts influence his all life he is avoiding to go out of his apartment, poorly sleep, he insisted to be admitted to in patient treatment because he „would probably kill himself if he had to stay there jet…” His first difficulties appeared when he was 20, after his first sexual experience which he has had with prostitute, after his friend’s birthday party. Then he obsessively started to think about getting AIDS, getting died… Four years ago he really have got malignant testicular tumor and in his 24he had passed through exhausting surgery and chemotherapy. As a child he was growing up during the war time, experienced snake bite, often tonsil infections.Now he has no job, live with parents and one year older brother, no girlfriend or other relationship. Treated with antidepressant venlafaxin, and atypical narcoleptic risperidon, with additionally used EMDR, he showed good recovery and getting into every day activities.ConclusionMoral conflict and unsolved guilty feelings lead to real illness and constant fear of fatal disease as a punishment for him.

IntroductionPatients with Acute alcohol intoxication (F 10.0) are referred most often to psychiatry or internal departments.AimTo examine some epidemiological characteristics of patients with acute alcohol intoxication treated at the admission departments of Psychiatry and Internal Medicine in Tuzla during 2009 year.MethodologyWe selected from the admission protocols 91(1.8%) of 5 055 patients examined in Psychiatry, and 76(0.5%) of 14 460 patients examined in Internal Medicine admission, who were diagnosed with F 10.0 according to ICD-10. Observed variables were sex, age, treatment they received at the admission departments and the instructions given for further treatment.ResultsWe found that Majority of them were males. Patients referred to the Psychiatry were somewhat older (43.2 years), than patients in the Internal Medicine (38.4 years). The most common referral to the Psychiatry was in March 14(13.4%), and November 11(12.1%), while in the Internal Medicine there were 9(14.28%) in November and 8(12.69%) in December. At Psychiatry, 29(31.86%) patients were hospitalized and 62(68.13%) continued with outpatient treatments. At Internal Medicine 40(52.6%) of 76 patients were detoxified, 30(39.47%) patients were referred to the Department for Psychiatry, while in-home treatment was offered to 40 patients (52.63%).ConclusionThe prevalence of acute alcohol intoxication compared to other diagnoses is higher in the Psychiatry admission than in the Internal Medicine, males were more frequent patients, and patients referred to Psychiatry were somewhat older. The most frequent alcohol intoxication in Psychiatry was recorded in October and November, while in Internal Medicine it was in November and December.

IntroductionAfter war 1992–1995 in Bosnia and Herzegovina (BH), whole population was highly psych-traumatized. Mental health therapists had no enough capacities to meet needs of population. They are permanently in need to increase their psychotherapy capacities. EMDR is a powerful, state-of-the-art treatment. Its effectiveness and efficacy has been validated by extensive research. National Institute for Clinical Excellence (NICE) recommended it as one of two trauma treatments of choice.AimTo describe non profit, humanitarian approach in sharing skills of Eye Movement Reprocessing and Desensitization (EMDR) to mental health therapists in BH from Humanitarian Assistance Program (HAP) of UK & Ireland.MethodAuthors described educational process considering the history of idea and its realization through training levels and process of supervision.ResultsHighly skilled and internationally approved trainers from HAP UK & Ireland came four times to Psychiatry Department of University Clinical Center Tuzla in BH where they provided completed EMDR training for 24 trainees: neuro- psychiatrists, residents of neuro-psychiatry and psychologists from eight different health institutions from six different cities in BH. After finishing training process, trainees are obliged to practice their EMDR therapy in daily practice with real clients under the supervision process of HAP UK & Ireland trainers to become certified EMDR therapists. Regarding big physical distance between supervisors and trainees, supervision will be realized via Skype Internet technologyConclusionPsychotherapy capacities of mental health psychotherapists in postwar BH could be increased with enthusiastic help of EMDR trainers from HAP UK&Ireland.

IntroductionTreatment of alcoholics is complex and difficult, very often it demands complex psychopharmacotherapy.AimTo investigate characteristics of psychopharmacotherapy of inpatients alcoholics with brain computerized tomography (CT) during hospitalization on Psychiatry Department in Tuzla.MethodologyWe investigated 86 record files of inpatients that were treated from 01.01.2005 to 31.12.2009 year on Psychiatry Department, who had dismissed diagnosis Alcohol dependency F 10.2 according ICD-10, to whom computerized tomography of brain has been done durin hospitalization. Targeted variables were: age, marital status, working status, involvement in war fighting's, CT diagnosis, psychological findings, laboratory findings and characteristics of psychopharmacotherapy.ResultsThe mean age of observed patients was 50.1 ± 6.6 years. 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. Brain cortex atrophy positively correlated with silent stroke and glucose blood level.There were 72 (83.7%) inpatients that treated with antidepressants, 45 (52.3%) with sedating antipsychotic drugs, 10 (11.7%) atypical antipsychotics 12 (13.0%) with typical antipsychotics, 53 (61.6%) with hypnotics, 37 (43.0%) tranquilizers, 23 (26.7%) vitamin B. There was the most frequent combinations of antidepressants SSRI with promazine in 41 (47.7%), with diazepam 25 (29.1%), with zolpidem 20 (23.3%) and nitrazepam in 17 (19.8%) patients.ConclusionSSRI antidepressants were the most frequent used psychopharmacotherapy drugs, then sedating neuroleptics and hypnotics. The most frequent drug combinations were antidepressants, sedating neuroleptic or tranquillisers and hypnotics.

ObjectiveTo assess the frequency of silent brain infarcts and cerebral cortical atrophy in male alcohol dependant psychiatric patients in post war Bosnia and Herzegovina (BH).MethodsWe analyzed twenty male alcohol dependant patients who were treated in the Department of Psychiatry in University Clinical Centre Tuzla during one year period (July 2007-July 2008), and to whom Computerized Tomography (CT) scan of neuro-cranium were done, according to age, war engagement, brain trauma, employment, smoking and presence of silent strokes and cerebral cortical atrophy. The results were analyzed using descriptive statistics.ResultsAverage age of the group of patients studied was 48.8±6.0 years, and 13/20 was hospitalized for the first time. Eleven of 20 were engaged as soldiers during the 1992-95 war in BH. Four of them were wounded and two of them had air-blast injury and head stroke without concussion. Fourteen of twenty were unemployed, and two of them were retired. Only one was admitted with alcoholic delirium. Eleven of twenty were cigarette smokers. Half of them had CT objectified silent stroke, and sixteen of twenty had generalized brain cortical atrophy. Brain cortical atrophy was significantly negatively associated with war engagement, while silent stroke were positively associated with age of patients.ConclusionBrain cortical atrophy and silent brain stroke are frequent findings in computerized tomography of the brain in psychiatric patients with alcohol dependency.

The aim of this study is to show if the severe war trauma survived in early childhood (age 4-5) make significant influence in development of young person in adolescent age. As an experimental group we took 40 children age 15-16 years (born 1990-91.) who were in Srebrenica during the siege and its fall in July 11th 1995. As a control group we took 40 children age 15-16 (born 1990-91.) who live in a complete family (both parents alive), and did not leave their homes during the war time. We examined the number of traumatic events experienced during the war and after the war time using War Trauma Questionnaire and we got significant difference between the numbers of traumatic events experienced during the war and in post war situation (p<0,05). We measured the level of posttraumatic stress reactions using the Posttraumatic Stress Reaction Questionnaire and did not get significant difference. We also measured the level of depression using Depression Self-Rating Scale (Zung) and did not get significant difference between the two groups. We can conclude that inspide the numerous unpleasant life experiences in the past and nowadays children- adolescents age 15-16 did not show significant difference in experimental and control group at this part of development. It makes us open for further researches about copping mechanisms in children during the war time.Keywords:war- trauma, adolescents, child- experience, depression