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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.

Background: Non-pharmacological treatment for schizophrenia includes educational, psychotherapeutic, social, and physical interventions. Despite growing importance of these interventions in the holistic treatment of individuals with schizophrenia, very little is known about their availability in South-East European countries (SEE). Objective: To explore mental health care experts’ opinions of the availability of non-pharmacological treatment for people with schizophrenia in SEE. Methods: An online survey containing 11 questions was completed by one mental health expert from each of the following SEE countries: Albania, Bosnia and Herzegovina (B&H), Bulgaria, Croatia, Greece, Kosovo†, Montenegro, Moldova, North Macedonia, Romania, Serbia, and Slovenia. Data were collected on estimated rates of received non-pharmacological interventions, type of services delivering these interventions, and expert views of availability barriers. Results: In eight countries, the estimated percentage of people with schizophrenia who receive non-pharmacological treatments was below 35%. The primary explanations for the low availability of non-pharmacological treatments were: lack of human and financial resources, lack of training for clinicians, and pharmacotherapy dominance in the treatment for schizophrenia. Conclusion: Lack of personal and institutional resources and state support were identified as primary obstacles to staff training and delivering non-pharmacological treatments to people with schizophrenia on individual and systemic levels, respectively. This evidence can be used to improve holistic, evidence-based treatment for schizophrenia in the SEE countries.

Background: CMHTs deliver healthcare that supports the recovery of people with mental illness. They should achieve a sufficient level of good quality teamwork, composed of individual professional skills as well their adaptation within the clearly defined roles in teams in order to work efficiently. This paper analyses to what extent team members of five CMHTs newly implemented in five countries had introduced aspects of the recovery-oriented approach and evaluates what the team members’ perceptions on their collaborative care roles and their level of confidence with this role are.Method: A quantitative survey was administered among 66 professionals and peer worker including the Recovery Self-Assessment Tool Provider Version (RSA-P), the Team Member Self-Assessment Tool (TMSA), and demographic questions. Result: The RSA-P showed that all teams had the perception that they provide recovery–oriented practice to a moderately high degree after a training week on recovery-oriented care. Healthcare providers with fewer years of professional experience perceived more frequently that they operated in a recovery-oriented way (p=0.036, B -0.268). Nurses and peer workers did not feel confident or responsible to fulfil specific roles.Conclusion: Trainings on community-based practices and collaborative teamwork may facilitates recovery-oriented care and helps to improve team cohesion. Trial registration: Each trial was registered before participant enrolment in the clinicaltrials.gov database: Croatia, Zagreb (Trial Reg. No. NCT03862209); Montenegro, Kotor (Trial Reg. No. NCT03837340); Romania, Suceava (Trial Reg. No. NCT03884933); Macedonia, Skopje (Trial Reg. No. NCT03892473); Bulgaria, Sofia (Trial Reg. No. NCT03922425)

Background Community Mental Health Teams (CMHTs) deliver healthcare that supports the recovery of people with mental illness. The aim of this paper was to explore to what extent team members of five CMHTs newly implemented in five countries perceived that they had introduced aspects of the recovery-oriented, strength-based approach into care after a training week on recovery-oriented practice. In addition, it evaluated what the team members’ perceptions on their care roles and their level of confidence with this role were. Method An observational intervention study using a quantitative survey that was administered among 52 health professionals (21 Nurses, 13 Psychiatrists, 9 Psychologists, 8 Social Workers) and 14 peer workers including the Recovery Self-Assessment Tool Provider Version (RSA-P), the Team Member Self-Assessment Tool (TMSA), and demographic questions was conducted. The measures were self-reported. Descriptive statistics were used to calculate the means and standard deviations for continuous variables and frequencies and percentages for categorical variables (TMSA tool and demographic data). The standard technique to calculate scale scores for each subscale of the RSA-P was used. Bivariate linear regression analyses were applied to explore the impact of predictors on the subscales of the RSA-P. Predictors with significant effects were included in multiple regression models. Result The RSA-P showed that all teams had the perception that they provide recovery–oriented practice to a moderately high degree after a training week on recovery-oriented care (mean scores between 3.85–4.46). Health professionals with fewer years of professional experience perceived more frequently that they operated in a recovery-oriented way (p = 0.036, B = − 0.268). Nurses and peer workers did not feel confident or responsible to fulfil specific roles. Conclusion The findings suggest that a one-week training session on community-based practices and collaborative teamwork may enhance recovery-oriented practice, but the role of nurses and peer workers needs further attention. Trial registration Each trial was registered before participant enrolment in the clinicaltrials.gov database: Croatia, Zagreb (Trial Reg. No. NCT03862209); Montenegro, Kotor (Trial Reg. No. NCT03837340); Romania, Suceava (Trial Reg. No. NCT03884933); Macedonia, Skopje (Trial Reg. No. NCT03892473); Bulgaria, Sofia (Trial Reg. No. NCT03922425).

Background: It is considered that depressive disorder most often begins in the reproductive period, around 20 years of age. Introduction: The greatest risk or danger for the young depressed mother is suicide, which is being considered the second cause of death in the young during the reproductive years. Unfortunately, it happens usually at the end of the pregnancy or during the first postpartum year. Materials and methods: The investigation comprised 69 patients at the age between 18 and 44 years, with postpartum depression. Patients were diagnosed and treated during their pregnancy and postpartum period. Patients were analyzed by using a structured clinically diagnostic psychiatric interview, psychodiagnostic instruments for assessment of anxiety and depression, HAM-A and HAM-D. Depression and anxiety were evaluated in the beginning of the treatment and after three months of treatment. Patients were treated with psychological interventions and pharmacological treatment, SSRI or SNRI antidepressant therapy, during pregnancy or postpartum period. Results: Cross-sectional study was conducted in a 3-month-period and comprised 69 patients, of which 71.0% were at the age older than 30 years, and 29.0% younger than 30 years. Of these, 81.5% of patients received antidepressants, 24.6% received antipsychotics and anxiolytics, alone or in combination. Discussion: The results have shown a statistically significant presence of risk factors in patients with antenatal or postpartum depression. The results have shown a significant reduction of anxiety and depression after application of SSRI therapy and psychological individual and group interventions by empowering the mother to care for herself and her child. Conclusion: Proper care for the mental health of the mother is the care for the entire society, healthy mother, healthy children and healthy society. Early recognition of the risk factors for development of antenatal depression leads to prevention of onset of antenatal or postpartum depression.

BACKGROUND: Mother’s mental state during pregnancy is of substantial importance for the mother, but also for the infant and his/her future growth and development. Depressive maternal disorders during pregnancy have a significant influence on the development of the baby during pregnancy as well as on the future development and mother-baby relation, the breastfeeding process and care for the baby. AIM: This study aimed to determine the influence of SSRI antidepressant therapy and psychosocial and therapeutic interventions on depression during pregnancy. It was also our aim to determine the relation between severity of depression and sociodemographic characteristics. METHODS: The study included 40 women, with diagnosis F32 and F33 according to ICD 10, that is, with severe depressive disorder within depressive episodes or recurrent depressive disorder. Patients were evaluated at the beginning of the treatment and 3 months after antidepressant treatment. They were followed-up for two years. RESULTS: The results obtained have shown that a larger number of mothers treated with antidepressant medications, had normal childbirth with the unremarkable condition of both, the mother and the newborn baby. CONCLUSION: A well-combined treatment of maternal depression during pregnancy reduces the risk of postpartum depression, which is by itself a prerequisite for normal emotional and behavioural development of the child.

BACKGROUND: The depressive disorder is one of the most frequent mental disorders, which is often associated with severe dysfunctionality. Personality traits are considered as important factors for the occurrence of depressive disorder.AIM: To determine the specificity of personality dimensions as predictive factors of depressive disorder.METHODS: This research was conducted at the University Psychiatric Clinic Skopje as a "case-control" study. TCI-R (temperament and character inventory – revised) was used as the main research instrument.RESULTS: There are specific personality traits expressed through high scores of Harm Avoidance and low scores of Self –Directedness traits as predictive factors related to an incidence of the depressive disorder.CONCLUSION: The results of this study show that certain personal traits, and more specific HA and SD, are with a specific predictability of the depressive disorder.

BACKGROUND: The depression is a cross-cultural condition that occurs in all cultures and within all nations with certain specificities, even though there are some differences in its manifestation. The hereditary load is of major importance, but also the individual personality factors, in the form of risk factors, are associated with the occurrence of depression. Personality characteristics have a significant impact on the occurrence of the recurrent depressive disorder and the outcome of the treatment as well.AIM: To identify the specific personality traits in people with the recurrent depressive disorder and the impact of the affective state on them.METHODS: Three questionnaires were used: a general questionnaire, Beck's scale of depressive symptoms, and TCI-R (inventory for temperament and character).RESULTS: The most indicative differences in the dimensions are found in the Harm avoidance and the Self-direction dimensions, and most variable dimensions dependent on effective state are Novelty seeking and Reward dependence.CONCLUSION: The people with the recurrent depressive disorder have a different profile of personality traits (temperament and character) compared with the control group, and their characteristics depend on their current affective state.

INTRODUCTION: Patients with schizophrenia have severe problems with self-care which affects their quality of life.OBJECTIVE: The aim of the paper was to monitor self-care in patients with schizophrenia and to find out the differences regarding socio-demographic characteristics and ambulatory and day hospital treatment.METHOD: The investigation included 120 subjects each with diagnosis F20 according to ICD 10 criteria; divided in two groups of 60 patients regarding their actual treatment (the first group received ambulatory care whereas those from the second group had a day hospital treatment). Patients were of different age and gender, receiving regular antipsychotic therapy. They were included in individual and group psychosocial therapeutic procedures during the day hospital treatment. The investigation utilized the following diagnostic instruments: standardized clinical interview and Personal and social performance scale (PSP scale), non-standardized questionnaire of socio-demographic data, family support and existence of mental disorder in other family members.RESULTS: The results have shown better personal and social functioning in patients who had family support, in those who are employed, in those with no mental disorder in other family members and in patients on day hospital treatment against patients receiving ambulatory care.CONCLUSION: Day hospital treatment, family support and social support improve self-care of patients with schizophrenia.

The sleep-related problems of shift workers usually occur as transient phenomena related to the timing of work. Sleep disorders, related to sleep deprivation, have a major impact on the quality of life and health status of healthcare workers. Reduced quantity and quality of sleep negatively affects the activities of shift workers, particularly in terms of their social functioning, quality of life and health. However, it seems that health authorities and the medical staff are negligent when it comes to the negative effects on health caused by work in night shifts. Recently published studies in this field suggest that appropriate public health preventive programs dealing with sleep disorders successfully contribute towards the quality of life of workers.

BACKGROUND: World statistical data show that a large number of individuals suffer from posttraumatic stress disorder (PTSD) after exposure to the intense traumatic event. PTSD can have a chronic course with enduring changes in the functioning of the person.CASE PRESENTATION: Here we report two adult individuals of different gender and education who were exposed to the extremely severe stressful event after which difficulties in psychological functioning developed. The first case we present is a 46-year-old man, with completed high education, divorced, father of two children, who lives with his parents, and is retired. Disorders appeared 20 years ago when he was exposed to extremely severe stressful events in war circumstances that included captivity, torture, and loss of fellow soldiers. The second case is a 50-year-old female patient, with a university degree, professor of art, married, and mother of two children of whom the son died six years ago. She suffered from disorders after the sudden injury of her son that ended with his death.CONCLUSION: Posttraumatic stress disorder after the intense stress is a risk of development enduring personality changes with serious individual and social consequences.Â

The functioning of the human body is regulated by the rhythmical change between rest and activity. The SCN (suprachiasmatic nucleus) is responsible for the central control of the biorhythm and the genetic prediction of the individual chronotype, whereas peripheral time cues such as light, social contacts and times of meals modulate the rhythmical activity of the body. Shift workers suffer from a disruption of the sleep-wake rhythm, insomnia and a lack of melatonin. These factors might trigger the development of breast cancer in female shift workers. The growing amount of data which indicate the high risk of breast cancer in female shift workers demonstrates the need for the implementation of prevention strategies against insomnia in shift workers. These strategies include regular sleep education courses on the prevention of sleep disorders in companies. The individual chronotype could be an important predictor for the adaptability to shift work.

Eight community mental health care centres (initiated by the South-Eastern Europe Stability Pact) in Albania, Bosnia-Herzegovina, Croatia, Macedonia, Moldova, Montenegro and Romania were evaluated. Characteristics of patients, patient reported outcomes and patient views of care were assessed in 305 psychiatric patients. Patient characteristics varied across centres, with most patients having long term psychotic disorders. Treatment satisfaction and therapeutic relationships were rated favourably. Subjective quality of life mean scores were rather low, with higher satisfaction with health and dissatisfaction with the financial and employment situation. Being unemployed was the only factor associated with poor quality of life and lower treatment satisfaction. Most developing centres target patients with persistent psychotic disorders. Care appears highly valued by the patients. The findings encourage establishing more centres in the region and call for employment schemes for people with mental illnesses.