Alma Bravo-Mehmedbasic[show abstract] [hide abstract]
ABSTRACT: Risperidone is a second generation antipsychotic agent, with potent serotonin 5-HT2A and dopamine D2 receptor blocking effects. Specifically, risperidone possesses a unique balance of serotonin and dopamine antagonism, namely that its affinity for 5-HT2A receptors is significantly greater than its affinity for D2 receptors. Risperidone is well-established medication, with the proven effects on positive and negative symptoms of schizophrenia. The aim of research was to establish the effectiveness and safety of risperidone in patients with schizophrenia. The sample consisted of 60 subjects, age ranged was between 18-60 years, both genders, who met the criteria for the diagnosis various types of schizophrenia, according to ICD-10 (International Statistical Classification of Diseases). They were enrolled in the study as outpatient and inpatient setting. All subjects signed informed consent before entering into this study which had been conducted at the Psychiatric Clinic, University Clinical Center Sarajevo. Study was designed for 8-week, open-label, flexible-dose observational study. The subjects had to have a total score > -40 on Positive and Negative scale -two parts of the Positive and Negative Syndrome Scale (PANSS), and to be able to discontinue current antipsychotic medications. The primary efficacy parameter was the percent of score difference between baseline and week 8 of therapy on two above-mentioned PANSS subscales. The difference was considered as significant improvement if decrease from the baseline was 20% or more. The secondary efficacy parameter was subjective clinical evaluation of efficacy with five possible answers: very good, good, moderate, not satisfactory, not possible to evaluate. It was measured at the end of observational period by the investigator. All 60 enrolled patients completed the study. After the 8 weeks of treatment, 54/60 patients (90%) had clinically significant improvement of 20% or more decreased total PANSS score (Positive and Negative subscale). In 6/60 patients (10%) clinical improvement was also reported with less of 20% decreased total PANSS score. The side effects were registered in 8/60 patients (13.32%). The mild extrapyramidal symptoms registered in 1/60 (11.66%) patients, whom dose of risperidone was reduced. Increase of prolactine in 7/60 (11.66%), patients, whose dose of risperidone also were reduced. Average weight gain was 0.84 kg. In this study Risperidone has shown very good effectiveness and safety.Medical Archives 01/2011; 65(6):345-7.
Article: Treatment outcomes and costs at specialized centers for the treatment of PTSD after the war in former Yugoslavia.Stefan Priebe, Jelena Jankovic Gavrilovic, Aleksandra Matanov, Tanja Franciskovic, Goran Knezevic, Damir Ljubotina, Alma Bravo Mehmedbasic, Matthias Schützwohl[show abstract] [hide abstract]
ABSTRACT: Posttraumatic stress disorder (PTSD) is a frequent consequence of war experience, and specialized centers have been established in some war-affected areas to provide treatment. This study assessed treatment costs and outcomes in such centers in former Yugoslavia. An observational study was conducted in four specialized treatment centers (in Serbia, Croatia, and Bosnia-Herzegovina). A total of 526 consecutive adult patients with war-related PTSD were assessed at the beginning of treatment, and 463 met inclusion criteria, including a diagnosis of PTSD on the Clinician-Administered PTSD Scale for DSM-IV (CAPS). For most patients seven years had elapsed between the traumatic experience and treatment at the specialized center. Service costs were also assessed. Outcomes measured at one year were the presence of a PTSD diagnosis and severity of symptoms as indicated by the CAPS score and subjective quality of life as measured by the Manchester Short Assessment of Quality of Life. At 12 months 380 (82%) patients were followed up, and 325 (86%) met criteria for PTSD. Symptoms and quality of life showed overall small but statistically significant improvements. Treatment costs for patients with and without PTSD at 12 months did not significantly differ (euro 307 and euro 284, respectively). The recovery rate among patients treated in specialized centers for war-related PTSD several years after the war was poor (14%), and symptom improvements were small. The recovery rate was not linked to service costs. Improving recovery rates might require different treatment methods or different service models.Psychiatric services (Washington, D.C.) 06/2010; 61(6):598-604. · 2.81 Impact Factor
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ABSTRACT: Research data from studies of functional neuroanatomy and neurochemistry indicate various dysfunctions in certain areas of the brain in individuals who suffer from chronic Posttraumatic Stress Disorder. These abnormalities are involved in the evolution of symptoms of PTSD, deterioration of cognitive functions and decreased quality of life of the survivors. The intensity of these symptoms is in direct correlation with the degree of dysfunction in the central nervous system. The aim of our study, was to evaluate the subjective perception of the Quality of life in subjects suffering from chronic PTSD and to compare prior to treatment results to results three and six months after receiving therapy, as well as to analyze whether perception of the Quality of life change related to treatment. The study was conducted at the Psychiatric Clinic of the Sarajevo University Clinical Center. The sample consisted of 100 male persons, with war trauma experiences, whose age range was between 35 and 60 years, who were seeking treatment at the Psychiatric Clinic, University of Sarajevo Clinical Center and met the criteria for the diagnosis of chronic PTSD (Posttraumatic Stress Disorder) according to ICD-10. (International Statistical Classification of Diseases and Related Health Problems, 10th Revision). The exclusion criterion was prior psychiatric illness (traumatization before the war) and less than 8 years of education. All subjects received out-patient treatment. Their treatment involved psychopharmacological and psychotherapeutic therapy. The subjects were assessed using the following instruments: Sociodemographic Questionnaire designed by the authors for registering the social and demographic characteristics of the subjects (age, years of education, current employment, and socioeconomic status) and Manchester Quality of Life Scale (MANSA) as a self-report scale. The subjects were assessed prior to treatment, and three and six months after beginning the treatment (follow-up). There was an increase in the mean values of subjective perception of Quality of Life between the first (3.2352), second (3.4447), and third test (3.6090). Differences between these mean values were not statistically significant between the first and second test, but significant between the second and third test. Also differences between sociodemographic characteristics prior to treatment and during six month follow-up were not statistically significant. A significant increase has been noted in the number of contacts with close friends between the first, second and third test. Also, we recorded a decrease in pertaining aggressive and criminal behavior between the three tests. The results of our study indicate that subjects who are suffering from chronic PTSD have a lower subjective perception of their quality of life. Combined psychopharmacological and psychotherapeutic treatment over a period of six months lead to improvement in the perception of quality of life. This may indicate the need for longer treatment of individuals suffering from chronic PTSD. A significant increase has been noted in the number of contacts with close friends between the first, second and third test, reflecting positive treatment effects on everyday life functioning and coping skills.Psychiatria Danubina 09/2010; 22(3):430-5. · 0.44 Impact Factor
Alma Bravo-Mehmedbasic, Dubravka Salcic, Abdulah Kucukalic, S. Fadilpasic, L. Cakovic, Enra Mehmedika-Suljic, Izet Masic[show abstract] [hide abstract]
ABSTRACT: Introduction: Through psychological support for prison guard's awareness about professional stress and burn-out, cognitive assessment of stress consequences, insight in coping strategies, as well as prevention of stress consequences is achieved. Aim: Evaluation of psychoeducation effects on professional stress consequences within prison guards. Method: In the research were included 122 prison guards from three prisons in Bosnia and Herzegovina. All of them have been tested before and after psychoeducation was finished using following instruments: Index of reaction, STAI questionnaire, SAMAČA questionnaire. Results: Differences between first and second measuring of subjects included in this study in Sarajevo prison indicated statistically significant reduction of stress reactions, improvement of coping strategies and communication skills. In prisons Zenica and Kula there are differences between first and second measurement in stress reactions reduction, improvement of coping strategies and overcoming of stress and improvement of communication skills as well, which are not statistically significant. In Kula prison, significant differences between two measurements in attitudes of prison guards toward detainees were observed. Conclusions: Results of this study show that prison guards within prisons where are detained persons with long period of imprisonment are more exposed to professional stress, comparing to prison guards who are employed in investigation prison. Psychoeducation resulted in positive effects and it should be obligatory included in prison guards training with the aim of decreasing of psychological consequences of prolonged professional stress to which they are exposed to. Psychoeducation should be on continuous basis and led by educated mental health professionals.Materia Socio Medica 03/2009; 21(1):24-6.
Article: The Importance of Group Psychotherapy in the Rehabilitation of War Survivors with Psychological Consequences[show abstract] [hide abstract]
ABSTRACT: Aim: To demonstrate the importance of group psychotherapy in the rehabilitation of war survivors with psychological consequences. Method: The study involved 12 subjects (7 male and 5 female), with war psychological consequences. Assessment instrument used in this study was Brief Symptom Inventory (BSI-53), containing 53 items divided in 9 subscales. Questionnaire ranging from 0 to 4 was used for assessing psychological symptoms. The subjects were assessed prior to the treatment, with six months follow-up. All subjects were treated with group psychotherapy. Sessions were organized weekly and lasted for one and half hour. Group was lead by two co-therapists, one male and one female. Working technique was supportive-expressive psychotherapy. Results: After six months of psychotherapy treatment of the group, BSI -53 questionnaire results show reduction in all psychopathological symptoms (p<0, 05). Conclusion: Group psychotherapy can be recommended as a technique in the psychotherapy of war related psychological consequences.Medical Archives 01/2009; 63(5):266-7.