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Background Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. Methods We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. Findings Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. Interpretation Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. Funding Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.

Rehabilitation programmes for treatment and management are needed that specifically focus on psychotic disorders, severe personality disorders and drug abuse.

<p>Psychiatric and physical illnesses frequently coexist. Depression is associated clinically with heart disease in several ways, including risk of arrhythmia, alteration of the amount of blood flowing to the coronary arteries, increased risk of blood clots, and increased risk of cardiac arrest. Depression may even be an independent risk factor for mortality in individuals with cardiovascular disease (CVD), something that should concern those involved in the treatment of those patients.</p> <h4>ABOUT THE AUTHORS</h4> <p>Nazmie F. Ibishi, MD, is a Psychiatrist with the University Clinical Center of Kosova, Clinic of Psychiatry, Prishtina, Kosova. Nebi R. Musliu, MD, is a Cardiologist with the University Clinical Center of Kosova, Clinic of Cardiology. Ahmet Kamberi, PhD; Spiro Qirko, PhD; Sabit Brokaj, PhD; and Mimoza Lezha, PhD, are with University Hospital Center of Tirana, Clinic of Cardiology, Albania. Bekim Haxhiu, MD, is with Primary Care Service, Prishtina, Kosova, John Masala, MD, is a Psychiatrist with Dubrava Prison Hospital, Kosova.</p> <p>Address correspondence to: Nazmie F. Ibishi, MD, University Clinical Center of Kosova-Clinic of Psychiatry, Prishtina, (Kosova); or e-mail <a href="mailto:nazmiemb3@hotmail.com">nazmiemb3@hotmail.com</a>.</p> <p>Dr. Ibishi, Dr. Musliu, Dr. Kamberi, Dr. Qirko, Dr. Brokaj, Dr. Lezha, Dr. Haxhiu, and Dr. Masala have disclosed no relevant financial relationships.</p> <h4>EDUCATIONAL OBJECTIVES</h4> <ol><li> Assess the impact of depression in cardiovascular disease (CVD) patients. </li> <li> Determine the relationship of depression and CVD, including biological and behavioral factors. </li> <li> Explain the signifi cance of early recognition of depression in CVD patients and the role of indirect self-destructive behavior as an independent risk factor for morbidity and mortality in these patients. </li></ol>

PurposeMedia reports and the official statistics published after the war in Kosova demonstrate a rising trend of suicide in general population. In the past in our clinic have been little interest in whether suicidal risk and behavior has been documented and whether these signs of risk and suicide behavior is associated with Mental disorder and PTSD.Methods134 offenders hospitalized in period time 2007–2009 were included. We used DSM-IV criteria, SBQ-R and assessed risk of suicide factors.Results31,9% were diagnosed with personality disorder, 21,3% were psychotic, 8,5% were drug abusers, 21,3 were depressed with PTSD signs of trauma war, and 17% of them without diagnosis. Risk factors such are abnormal behavior, isolation, hopelessness, depression or other mental disorder, family problems or personal loss and drug or alcohol intoxication were important risk factors for suicidal behavior in 73% of them.12,8 % reported attempt of suicide, 14,9% of them reported that have had a plan to kill themselves, 40% reported that have told someone that are going to commit suicide, and 23,4% reported that they are likely to attempt suicide someday. Suicidal thoughts and attempts were commoner in forensic setting than in general population and were significantly associated with Personality disorder, Psychosis and PTSD.ConclusionSuicide behavior and its significant association with mental disorder play an important role and should include training programs in recognition of offenders at high risk behavior and preventive programme management in forensic settings in our country.