International Conference sponsored by the European Society for Child and Adolescent Psychiatry (ESCAP) Quality of Life in Child

and Adolescent Mental Health; 22-26 August 2009, Budapest, Hungary

CLINICAL SURVEY: FIRST EIGHT YEARS OF

CHALLENGE IN BUILDING OF A CHILD AND
ADOLESCENTS MENTAL HEALTH UNIT IN
POST WAR COUNTRY
Dr.NAIM FANAJ, Psychiatrist;
Children and Adolescent Mental Health Unit; Main Family Health Center PRIZREN, KOSOVA

5. Drop-out of the evaluation /treatments during the 2002 -2008

INTRODUCTION
Prizren is a second biggest town in the Kosovo. Since the
2001 in this town has started building of Health Unit of Child
On the chart 1 we did grouping of the diagnoses in several
categories based on the ICD-X classification
250
This parameter has been realized for years 2002 -2008 because
we didn’t had data for the year 2001. From 956 cases we have
found that level of drop -out of appearance on the evaluation
F 93 and treatments have had significant number of 55 %.
F 98.0

and Adolescents Mental Health. The mentioned center is 200

Z 03.2
F 70-79
second one in regards of the format in the country. Its F 98.5
150 17%
establishment was and still is one big challenge. Kosovo F 91
F 44-45 28%
comes up from the war, with socio-economical difficulties, 100 Z 63.4
with lack of the similar activities in the past and lack of the F 23 Continued
Discharge
50 F 32
professionals. Until the 2004, we use to work only once per F 84
week due to the residential program and then with the full 0
1
F 51

time. This unit is developing on behalf of the Primary Health F 95

Drop-out
Care within the Main Family Health Center in Prizren from
which is supported financially. Chart 1. Presentation for the disorders which are diagnosed grouped in the
category based on the ICD-X 55%

METHOD We also look for movement of the case numbers based on Chart 4. Percentage of follow-up for all
the specific diagnoses within the years. It can be meant
full domination of the cases with the Enuresis in the first From the 526 cases that have interrupted treatments, after the
We have made review of the data from the non clinic work
verifying of their place of residence we have found that 252 of
for eight years in the past. We have achieved to review the years is finishing within the last three years, although in
them were from the villages and 274 from the town; these
data for 1026 referred cases evaluated and treated in the past the last year it is seconded after the cases with the Acute cases based on the percentages didn’t had huge differences –
years. We were using the retrospective method to review our Stress Disorders diagnose. Within the years cases with the those from the villages has been 56, 1 % from the all cases
work. Data processing has been done with help of Excel RM and Stuttering are stable. A second drift is rapid referred from villages and those from the town were 54 % of
program, using the table and graphic view of results. increasing of the cases with anxiety disorders in the year the all cases referred from the town.
2005 having a second place within the mentioned year, After we have verified the time of interruption, on which
but it wasn’t repeated in other years. It means that during session, we have found that 45,2 % of the cases has been
the time been, disorders overview is becoming more devious since the first meeting; there is one difference from 10
RESULTS general, although the “light” diagnosis such as: Enuresis, % more of cases from the villages comparing to those from the
Stuttering, RM are continuing to be more often. town.
We have been focused on the possible links in between the
1. General data for the work of Mental Health Unit referral sources with the interruption. Also, we found that 64,
36 % of the cases referred from the familiar doctors have
interrupt their attendance, then we have 62, 26 % of cases
Since the beginning of our work, on 2001 we had 1026 referred by pediatric, 60 % of cases referred by psychiatric. As
3. Medicaments (drugs) description
referred cases. The numbers of the evaluation appointments most “disciplined “one has been cases referred from the
and treatments for the mentioned cases was 3994; with the schools with 37 % and then from the logopedic with 40, 81 %.
We have ascertained that only for 20% of cases we have
average of 3, 17 meetings for each case. A 57 % of the After we verified which diagnose of the cases can be most
prescribed medicaments; more prescribed drug was
referred cases are males and 43 % are females. 53 % of the “non-disciplined” on the attendance, we found that in cases of
mentioned cases are from the urban place of the region and 47 Lorazepam for 74 cases, then Imipramin within the 58 Behaviors disorders about 74 % of cases have interrupted
cases. Those two types are 50% of all prescribed drugs. evaluation/treatment; those with the Enuresis with 73, 85 %,
% are from the rural parts. We have found that within 44 % of
Anti-depressives are prescribed in 43, 33 % of the cases. ASD with 68,75 %, anxious disorder with 58,33 %.
cases are presents age period between 7-12 years. This
generation is guiding to the both genders.
In order to have clear picture, we take out the cases which
didn’t resulted with the psychiatric diagnoses and those that 4. Case referral within the years 2005 – 2008 CONCLUSIONS
we didn’t achieved to evaluate completely; ex. We have left
only those cases which have resulted to be with the psychiatric  Data collected from patient’s histories through 2001-
disorders based on the ICD -X. It is impossible to see the 2008 years in Child and Adolescent Mental Health Unit –
differences on the category presence from the data of the all Prizren, has presented one sample which maybe is still far
referred cases (table 1) 1%2%
1% from being representative for mental health problems in
9% FD/MD our population.
4% Family  CAMH in Kosova are somehow novelty for families
Logoped and for our medical services; especially is our
4%
41% Psychologist
Age-
group
Female Male comprehensive approach in spite of our traditional
Rural Urban Total Rural Urban Total 5% Psychiarist medicinal approach.
School  Stigma, especially in youngest age remains the big
Nr % Nr % Nr % Nr % Nr % Nr %
8% Pediatric problem.
0-6 y 27 3,4 51 6,43 78 9,84 46 5,8 84 10,6 130 16,41
Neurologist  The permanent engagement is needed to maintenance
7-12 y 78 9,84 67 8,45 145 18,3 97 12,24 114 14,39 211 26,64 NGO vital collaboration with referral agencies in interest of
CMHC users;
13-18 y 62 7,82 47 5,93 109 13,76 55 6,94 34 4,29 87 10,98
25%
 Closeness of services in term of acceptability and also
18 + y 7 0,88 7 0,88 14 1,76 9 1,13 7 0,88 16 2,02
in physically distance, remain big worry for
Total 174 21,94 172 21,69 346 43,66 207 26,11 239 30,16 443 56,05 comprehensive regional level; hard socio -economic
Chart 2: Graphical presentation of percentages of the referred cases based on situation, distance of services sometimes did “excessive”
the sources of referall. one long assessment and comprehensive treatment.
Table 1: Presentation of the case numbers and percentage based on the ages,  We need the deeper investigations to know features of
gender and places of residence (excluded cases without the diagnose)
pathology and also to estimate all problematic of one
country.
 Child and adolescent mental health services are
2. Presentation of the ascertained disorders essential in our country. We like to strengthen and to do
We sow trends of the referrals within the last 4 years and
we have found that referrals from the familiar doctors had full functionalization with multi-disciplinary approach.
On the following table we have presented diagnoses for the
lightly downfall during the year 2006 which kept same
cases within the years 2001 – 2008, and we have excluded
level of referral, whereas within the last two years, there
seconded diagnoses.
was increasing of the referrals from the families,
especially within the last year. In the soft increasing, last
Diagnosis/State Nr % References
Enuresis 183 17,83
two years, we have had from the pediatric.
MR 113 11,01 1
Stuttering 92 8,96 Burns BJ, Costello EJ, Angold A, et al. Data watch: children's mental health
service use across service sectors. Health Affairs, 1995; 14(3): 147-59.
Unfinished assesment 92 8,96 2
L.Jones, A.Rrustemi,M.Shahini, A.Uka, Mental health services for war -
Anxiety dis. 89 8,67 affected children;Report of a survey in Kosovo,British Journal of Psychiatry,
80
Non-psychatric 84 8,18 ,183, 540-546
70 FD/GP 3
Acute Stress dis 64 6,23 Rutter M.,Taylor E.,Hersov L.:Child and Adolescent Psyhiatry,Modern
Anx.-depress. dis 34 3,31 Family aproaches,Third edition; Blackwell Scientific Publications,1994
60 4
Logoped Kaplan H.,Sadock B.:Comprehensive Textbook of Psyhiatry, Sixth edition,
Bereavment 26 2,53 Williams& Wilkins,1995
50 Psychologist
Somatoform dis 21 2,04 5
Dulcan M.,Martini R.:Concise guide to Child and Adolescent
Psychiatrist
Psychotic dis 18 1,75 40 Psyhiatry;second edition, 1999,Washington ,London
School 6
Depressive dis 18 1,75 30 Pediatric
American Psychiatric Association (2000). Diagnostic and statistical manual
Conduct dis 17 1,65 of mental disorders, 4th Ed. Text revision. Washington, DC: Author.
Neurologist
20
Separation Anx dis 15 1,46 NGO
PTSD 15 1,46 10 CHMC ACKNOWLEDGEMENTS
Conversive dis 13 1,26
0 The author thanks Main Health Family Center PRIZREN for their help in
Tic dis 13 1,26
2005 2006 2007 2008 establishing the service and providing help and showing readiness to support
Child abuse 12 1,16
this poster edition.
Autistic spect. dis 12 1,16
ADHD 11 1,07
Chart. 3. Display of number of referall from agencies in years Naim M. Fanaj, M.D.
Table 2: Data presentations of the diagnosed disorder
 Adress: Str. Elbasanit, nn, 20000, Prizren, Republic of Kosova
based on the numbers and percentages.
 Tel.: + 377 44 192053
 Email: naimfanaj@hotmail.com