Title Promjene osobnosti u bolesnika s posttraumatskim stresnim poremećajem uzrokovanim borbenim iskustvom : doktorska disertacija
Title (english) Personality changes in patients with combat related posttraumatic stress disorder
Author Iva Nemčić Moro
Mentor Tanja Frančišković (mentor)
Committee member Tanja Frančišković (član povjerenstva)
Granter University of Rijeka Faculty of Medicine Rijeka
Defense date and country 2011-11-18, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences
Universal decimal classification (UDC ) 616 - Pathology. Clinical medicine
Abstract SAŽETAK
Pozadina istraživanja: U svjetlu strukturiranja novih izdanja klasifikacija bolesti, propituju
se kriteriji za neke kliničke entitete. Među njima je i trajna promjena osobnosti uslijed
traume/DESNOS koji se definira kao psihološka posljedica psihotraumatizacije, a njegovo
postojanje isključuje postojanje PTSP-a. Svakodnevna klinička praksa ovu stavku dovodi u
pitanje.
Cilj: Utvrditi moguću prisutnost Disorder of extreme stress not otherwise classified
(DESNOS) kod veterana Domovinskog rata s borbom uzrokovanim posttraumatskim stresnim
poremećajem (PTSP).
Metode: Istraživanje je uključilo 355 ispitanika u četiri centra u Hrvatskoj. Primijenjeni su
upitnici: Structured Interview for Disorder of Extreme Stress (SIDES- SR), te Međunarodni
neuropsihijatrijski intervju (MINI), Upitnik za poremećaj osobnosti DIP-Q, upitnik o kvaliteti
života MANSA, Upitnik traumatskih događanja – TAQ, Harvard Trauma Questionnaire
(HTQ): Croatian Version te opći demografski upitnik.
Rezultati: U ispitivanoj populaciji 43% veterana Domovinskog rata koji boluju od PTSP-a
zadovoljavaju sve kriterije i za DESNOS.
Na kliničkoj razini, ispitivani veterani zadovoljili su kriterije za sljedeće poremećaje
osobnosti: paranoidni, shizotipni, granični, izbjegavajući i opsesivno kompulzivni. Ispitanici s
izraženijim DESNOS-om imaju i izraženije simptome poremećaja osobnosti i to: granični,
paranoidni, opsesivno-kompulzivni, izbjegavajući i shizotipni. A ispitanici koji u potpunosti
zadovoljavaju kriterije za DESNOS, na kliničkoj razini zadovoljavaju, uz navedene
poremećaje i shizoidni poremećaj osobnosti. Na izraženost poremećaja osobnosti najviše
utječu posttraumatski simptomi, odnosno što su izraženiji posttraumatski simptomi to je više
prisutno simptoma poremećaja osobnosti. Simptomi trajne promjene osobnosti su jače
izraženi u osoba koje su bile više traumatizirane.
Ispitanici, koji uz PTSP imaju i DESNOS dva puta češće imaju u komorbiditetu: depresiju i/
ili socijalnu fobiju. Dijagnoza trenutnog paničnog poremećaja kod osoba s DESNOS-om se
javlja gotovo tri puta češće nego kod osoba koje imaju samo PTSP. Također, što je kod
ispitanika veći broj komorbidnih poremećaja uz PTSP, veća je i izraženost trajnih promjena
osobnosti uslijed traume.
Manje zadovoljstva s kvalitetom života može se predvidjeti kod ispitanika s ranom
traumatizacijom i s jače izraženim simptomima bilo PTSP-a bilo DESNOS-a.
Zaključak: Suprotno kriterijima postavljenima u ICD-10, rezultati ovog istraživanja govore
da se PTSD i DESNOS mogu javljati u komorbiditetu. Veći intenzitet simptoma te češći
komorbiditet s drugim psihijatrijskim poremećajima posebice depresijom, paničnim
poremećajem i socijalnom fobijom zahtjeva dodatne terapijske intervencije u procesu
liječenja veterana s DESNOS-om.
Abstract (english) Background: In light of new editions of the DSM and ICD classifications of diseases being
prepared, certain clinical entities are being reassessed. Among others, clinical entities under
reexamination are Disorder of Extreme Stress Not Otherwise Specified (DESNOS) or
Complex PTSD according to the classification of the American Psychiatric Association. The
corresponding diagnostic entity of the ICD would be Enduring Personality Change After
Catastrophic Experience, which, according to definitions, occurs as a psychological effect of
psychotraumatization and excludes the presence of PTSD. Day-to-day clinical practice casts
doubts as to the view that PTSD and DESNOS/EPCACE symptoms are mutually exclusive.
Aim: To determine possible presence of Disorders of Extreme Stress Not Otherwise Specified
(DESNOS) in Croatian war veterans who suffer from combat-related Posttraumatic Stress
Disorder (PTSD).
Methods: The research included 355 participants in four clinical centers in Croatia. It was
based on the following instruments: Structured Interview for Disorder of Extreme Stress
(SIDES-SR) and International Neuropsychiatric Interview (MINI), Questionnaire for
personality disorders DIP-Q, Quality of Life questionaire (MANSA), Traumatic Antecedents
Questionnaire TAQ, Harvard Trauma Questionnaire (HTQ): Croatian Version and General
Demographic Questionnaire.
Results: Forty three percent of veterans of the Homeland War in Croatia who suffer from
PTSD met criteria for DESNOS.
At the clinical level, tested veterans met the criteria for the following personality disorders:
paranoid, schizotypal, borderline, and obsessive-compulsive and avoidant. Veterans with
pronounced DESNOS have more often expressed symptoms of personality disorder as
follows: borderline, paranoid, and obsessive-compulsive, avoidant and schizotypal. The veterans who fully meet the criteria for DESNOS, at the clinical level meet - with listed
personality disorders - criteria for schizotypal personality disorder.
Posttraumatic symptoms affect mostly the expressiveness of personality disorders.
Enduring personality change symptoms are more pronounced in subjects who were more
traumatized.
Persons, who suffer from both, PTSD and DESNOS, twice more frequently suffer from
comorbid depression with melancholic features or social phobia.
DESNOS patients are almost three times more likely to have the diagnosis of current panic
disorder.
Furthermore, veterans who have more comorbid disorders with PTSD, have more pronaunced
permanent changes in personality due to trauma.
Less satisfaction with quality of life can be predicted in subjects with early trauma and more
pronounced symptoms of PTSD or DESNOS.
Conclusion: The research results demonstrate that PTSD and DESNOS can occur in
comorbidity, which is in contrast with the ICD-10 criteria. A higher intensity of symptoms
and a more frequent comorbidity with other psychiatric disorders, especially depression, panic
disorder and social phobia require additional therapy interventions in treatment processes for
DESNOS veterans.
Keywords
DESNOS
PTSP
veterani
komorbiditet
depresija
panični poremećaj
socijalna fobija
Keywords (english)
Posttraumatic Stress Disorder (PTSD)
Enduring Personality Change After Catastrophic Experience
Disorder of Extreme Stress Not Otherwise Specified (DESNOS)
complex PTSD
veterans
comorbidity
depression
panic disorder
social phobia
Language croatian
URN:NBN urn:nbn:hr:188:222438
Study programme Title: Biomedicine Postgraduate (doctoral) study programme Study programme type: university Study level: postgraduate Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
Type of resource Text
Extent 169 str.
File origin Born digital
Access conditions Open access
Terms of use
Created on 2017-01-19 17:19:26