PSIHOLOŠKE PROMJENE I RADNA SPOSOBNOST VETERANA
Suada Kapidžić-Duraković 1, Ljiljana Moro 2, Slobodan Pavlović 3
1 Klinika za fizikalnu medicinu i medicinsku rehabilitaciju
2 Klinika za psihijatriju, Univerzitet u Rijeci, Rijeka, R Hrvatska
3 Klinika za psihijatriju,Univerzitet u Tuzli, 75000 Tuzla, Bosna i Hercegovina

CILJ: Cilj rada je analizirati razlike u procjeni radne sposobnosti i samoprocjene veterana o istoj. Prikazati takođe psihološke promjene veterana.

ISPITANICI I METOD: Uzorak su sačinjavali veterani sa amputacijom ekstremiteta (grupa A, N=60), drugu grupu osobe sa paraplegijom (grupa B, N=60) i treću grupu osobe sa povredom perifernih nerava (grupa C, N=60). Za ispitivanje emocionalnog funkcionisanja upotrebljen je Profil indeks (PIE), korišten je Upitnik životnog stila i mehanizama odbrane (Lamovec,1990), a neurotske dimenzije ličnosti su ispitivane pomoću Minesota multifaznog personalnog inventara (MMPI). Za identifikaciju simptoma PTSP-a korišen je Upitnik koji je konstruisan prema dijagnostičkim kriterijima DSM-IV. Za procjenu preostale radne sposobnosti korišteni su podaci koji su dobiveni od strane ljekarske komisije i procjena radne sposobnosti po mišljenju samih ispitanika.

REZULTATI: Ispitanici grupe A su imali 8, grupe B 12 i grupe C 11 traumatskih događaja. Sa znacima hroničnog PTSP-a je 29 ispitanika grupe A (48,3%), 41 ispitanik grupe B (68,3%) i 32 ispitanika grupe C (53,3%), što ukazuje da veća fizička trauma dovodi do teže psihičke reakcije. Prema procjeni ljekarske komisije, u ukupnom uzorku od 180 ispitanika sposobnih za isti posao je 10 ispitanika ili 5,6%, dok sami ispitanici misle da je njih 62-oje sposobno za isti posao (34,4%). Nesposobnih za bilo kakav posao po mišljenju ljekarske komisije je 113 ili 62,8%, dok je po mišljenju ispitanika nesposobnih 30 ili 16,6%. Razlike u mišljenju su statistički značajne na nivou P<0,0001. Sposobni za isti posao postižu značajno viši skor na skali reprodukcije i skali inkorporacije od nesposobnih za bilo kakav posao (P<0,01), što je bilo za očekivati jer reprodukcija označava emocionalno stanje radosti nakon ispunjenja potreba ili želja, a inkorporacija odražava njihovu potrebu za radom. Ispitanici koji su se izjasnili da žele profesionalnu reedukaciju imaju značajno više rezultate na dimenziji eksploracije od ispitanika nesposobnih za bilo kakav posao i sposobnih za isti posao (P<0,01). Oni su opsesivni, rigidni, ne bi ušli u rizik donošenja konačnih odluka i praktično odgovornost prepuštaju autoritetima. Nesposobni za bilo kakav posao su depresivniji (P<0,0005) i agresivniji (P<0,005) od svih ostalih ispitanika. Na MMPI oni postižu značajno više rezultate na F skali, skali hipohondrije i histerije. Na K skali imaju značajno niži rezultat, dakle, ne vide sebe u budućnosti i suočavaju se sa svojom nemoći.

ZAKLJUČAK: Ukoliko onesposobljeni veteran nema znake PTSP-a, nema disocijativnih simptoma i pri tome želi da radi svoj posao, a ljekarska komisija procijeni drugačije, on se "gura" u psihopatologiju. Ako veteran ima simptome PTSP-a i ima disocijativne promjene, a izjavi da je nesposoban za bilo kakav posao, onda njegovo mišljenje treba uvažavati i liječiti ga pod kontrolom psihijatra. Zato je u timu za procjenu radne sposobnosti veterana pored specijaliste medicine rada i fizijatra, neophodno i prisustvo psihologa i psihijatra zbog procjene mentalnog statusa ispitanika.


PSYCHOLOGICAL CHANGES AND WORKING ABILITY OF VETERANS
Suada Kapidžić - Duraković 1, Ljiljana Moro 2, Slobodan Pavlović 3
1 Clinic for Physical Medicine and Rehabilitation, University of Tuzla, Bosnia and Herzegovina
2 Clinic for Psychiatry, University of Rijeka, Croatia
3 Clinic for Psychiatry, Tuzla, Bosnia and Herzegovina

AIM: Goal of this work is to analyze differences in working ability assessment of veterans, and by self-assessment of veterans themselves. To present psychological changes of veterans, too.

SUBJECTS AND METHODS: Sample was made of veterans with amputations (Group A, N=60), second group was made of people with paraplegia (Group B, N=60), and third group was made of people with peripheral nerves injuries (Group C, N=60). Emotional functioning was examined by Profile Index of Emotions (PIE), Questionnaire of Life Stile and Defense Mechanisms (Lamovec, 1990), and neurotic dimensions of personality were examined by Minnesota Multiphase Personality Inventory (MMPI). For identification of PTSD symptoms was used Questionnaire which was constructed by DSM-IV diagnostic criteria. For preserved working ability assessment data from medical team and self-assessment of veterans themselves were used.

RESULTS: A Group members had 8, B group had 12 and C Group11 traumatic events. With chronicle PTSD symptoms there were 29 members of A Group (48,3%), 51 member of B Group (68,3%) and 32 member of C Group (53,3%), which shows that larger physical trauma lead to harder psychical reactions. According to medical team assessment in sample of 180 examined persons, there were 10 people (or 5, 6%) able to do the same job they were doing before the injury. Examined persons felt that 62 of them were able to do the same job (34,4%). Unable to do any job, according to medical team, were 113, or 62, 8%, and according to the examined people 30, or 16, 6%. Differences in their thinking are statistically significant on P<0,0001. Persons with ability for the same job had significantly higher scores in reproduction and incorporation scales comparing to persons unable for any job (P<0,01), which is according to expectations because reproduction represent happiness after wishes came truth and incorporation represents their need to work. Examined persons who wish professional reeducation had higher score in exploration dimension comparing to unable examined persons and able for the same jobs (P<0,01). There are obsessive, rigid, they wouldn't risk with making final decisions and leave that to the authorities. Unable for any kind of job are more depressive (P<0,0005) and more aggressive (P<0,005) comparing to other examined persons. On MMPI they had statistically higher results on F scale, hypochondria scale and hysteria.

CONCLUSION: If disabled veteran don't have PTSD signs, dissociate symptoms and want to do his job, and medical team assess differently, he is being "pushed" in pathology. If veteran have symptoms of PTSD and dissociate changes and state that he is unable to do any job his status has to be taken seriously and he should be treated under psychiatric control. That is why medical team, beside occupational medicine specialists and physical medicine doctor need presence of psychologist and psychiatrist in assessment of patient's mental status.

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