POSTRAUMATSKI STRESNI POREMEĆAJ U VETERANA RATA I INVALIDNOST
Omerdić N1, Kusturica-Selimović A1, Kalajlić M2, Pranjić N1, 3.
1Dom zdravlja Tuzla, Tuzla, Služba za medicinu rada, Bosna i Hercegovina
2Univerzitetsko klinički centar Tuzla, Tuzla, Bosna i Hercegovina
3Medicinski fakultet Univerzitet u Tuzli, Katedra za Medicinu rada, Tuzla, Bosna i Hercegovina

Poznato je da ratni veterani trpe od ozbiljnih mentalnih poremećaja koji neminovno igraju veoma važnu ulogu u razvoju radne nesposobnosti ili preostale radne sposobnosti. CILJ: Cilj istraživanja je sticanje znanja o karakteristikama psihičkih poremećaja ratnih veterana sa PTSD, te značaj veze između PTSD i ratnih povreda u ocjeni radne sposobnosti.

ISPITANICI I METODE: Ispitanici su bili ratni veterani upućeni na medicinsku obradu tokom 2002. godine u našu ustanovu u svrhu ocjene invalidnosti i preostale radne sposobnosti (N=30; 29 muškaraca i jedna žena). Svi su ispitanici bili ratni veterani sa dijagnosticiranim PTSD, zaposlenika je bilo 26 (svi zaposleni u privrednim djelatnostima i rudarstvu; kvalificiranih radnika 8, nekvalificiranih 8, rudara 10), a 4 nezaposlena radnika. Nakon kompletne medicinske obrade bilo je 18 onih kod kojih postoji ratna povreda (ratni invaliditet) i PTSD, a 12 onih kod kojih je verificiran samo PTSD. Prosječna dob svih ispitanika iznosila je 47,27±7,69 godina, min 34 godine, max 61godina, a prosječan radni staž 25,40±6,75 godina, min 12 godina, max 35 godina. Bolesti i povrede klasificirane su prema Međunarodnoj statističkoj klasifikaciji bolesti, povreda i uzroka smrti, deseta revizija 1992. Statistička analiza učinjena je upotrebom metoda deskriptivne statistike, ?2 testa i Pearsonove korelacije.

REZULTATI: Najčešći psihički poremećaji u okviru PTSP bili su: trajni poremećaji afektiviteta u 10 (33,3%), teži depresivni poremećaj u 8 (26,7%), anksiozno-depresivni poremećaj u 6 (20%), paranoidni poremećaj sa teškim psihičkim krizama u 3 (10%), PTSP s kognitivnim poteškoćama u 2 (6,7%), i reaktivno stanje u 1 (3,3%) ispitanika. Utvrđena je statistički značajna korelacija između težine ratne povrede i psihičkih poremećaja PTSP-a (r=0,535; P<0,001). Najčešće bolesti koje su pratile PTSD bile su: kardiovaskularna oboljenja u 6 (20%), šećerna bolest u 3 (10%), i psihoorganski sindrom u 3 (10%) ispitanika. Najčešće komplikacije povreda bili su: epilepsija u 3 (10%), oboljenja muskuloskeletnog sistema u 8 (26,7%), hondrosarkom kosti u 1 (3,3%) i osteomijelitis u 1 ispitanika. Nijedan ispitanik nije bio sposoban za poslove u okviru zanimanja.

ZAKLJUČAK: Postoji nesklad u procjeni ratnog invaliditeta, koji je za PTSD bez ratne povrede iznosio od 0-20%, a ratne traumatske povrede od 30-100%. Međutim PTSD u ocjeni invaliditeta u odnosu na zanimanje je vodeći uzrok trajnog invaliditeta, i preostale radne sposobnosti, a ne ratna povreda.

POSTTRAUMATIC STRESS DISORDER IN WAR VETERANS AND INVALIDITY
Omerdić N1, Kusturica-Selimović A1, Kalajlić M2, Pranjić N3.
1Health Centre Tuzla, Tuzla, Service of Occupational Medicine, Bosnia and Herzegovina
2University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
3Medical faculty University of Tuzla, Department of Occupational medicine, Tuzla, Bosnia and Herzegovina

It is known that war veterans have severe psychological problems which necessary may be play very important role in involving of invalidity of these persons. AIM: The aim of this investigation is to obtain more information on characteristics of mental disorders in war veterans with PTSD, and the importance of the link between PTSD and war physical trauma in ability assess.

SUBJECTS AND METHODS: The subjects comprised 30 (29 male and 1 female) war veterans with verified PTSD who were sent to our Occupational medicine institution for medical examination for disability pension and on the contribution of these disorders to the permanent impairment. All subjects have been working as industrial workers and coal-miners, 26 of them (8 qualified of them, and 8 unqualified of them and 10 coal-miner) and 4 non-employed. After a thorough medical examination, there were 18 subjects with PTSD and war physical trauma, and 12 subjects with only PTSD. The mean age of all subjects were 47,27±7,69 years, min 34 years, max 61years, and mean duration of employed-time 25,40±6,75 years, min 12 years, max 35 years. The diseases and trauma were classified from International statistic analyse of diseases, traumas, and cases of mortality, X revision, 1992. Statistic analyse were made used methods of descriptive statistics, ?2 -test and Pearson-correlation.

RESULTS: The most frequent psychiatric disorder in PTSP picture was: permanent affective disorders of person in 10 (33,3%), serious depression disorders in 8 (26,7%), anxious-depressive disorders in (20%), paranoia disorders with psychic crisis in 3 (10%), PTSP with cognitive disorders in 2 (6,7%), and reactive status in 1 (3,3%) subjects. There were statistic significant correlation between level of physical trauma and PTSD (r=0,535; P<0,001). The most frequent disease which accompanied PTSD was: cardiovascular diseases in 6 (20%), diabetes mellitus in 3 (10%), and psycho-organic syndrome in 3 (10%) subjects. The most frequent complications of physical trauma consisted: epileptic disorder (3 subjects), muscle-skeletal disorders (8 subjects), sarcoma of bone (1 subject), bone- myelitis (1 subject). Nobody of these workers have ability for your job.

CONCLUSION: There are disagreement in the estimation of the war trauma invalidity, which for PTSD without war physical trauma were 0-20%, and which for war physical trauma were 30-100%. While, PTSD as factor of invalidity compared in relationship to occupation is mein cause of for disability pension and on the contribution of these disorders to the permanent impairment, but not physical trauma.