Psychotic symptoms and comorbid psychiatric disorders in Croatian combat-related posttraumatic stress disorder patients. (33/803)

AIM: To investigate the prevalence rate of post-traumatic stress disorder (PTSD) comorbid psychiatric disorders and to explore psychotic symptoms in patients with combat-related current PTSD. METHOD: The sample included Croatian war veterans (N=41) who were hospitalized at the University Department of Psychiatry of the Vrapee Psychiatric Hospital during the 1995-1996 period and fulfilled the DSM-IV criteria for the current and chronic PTSD. The Schedule for Affective Disorder and Schizophrenia (SADS-L) was applied for the assessment of current and lifetime psychiatric disorders. Only three subjects had a prewar Axis I psychiatric disorder. One third of the patients met the criteria for personality disorder. RESULTS: After severe combat trauma, the majority of PTSD patients (33/41) had at least one comorbid psychiatric diagnosis on Axis I. In those with personality disorders the most frequent was alcohol dependence, whereas in those without personality disorders it was major depressive disorder. Psychotic symptoms occurred in 8 out of 41 PTSD patients. None of them had a primary psychotic disorder or a personality disorder. In all the patients, psychotic symptoms were different from flashbacks. They were symbolically related to the trauma and resistant to antipsychotic treatment. Psychotic symptoms were associated with depression in 5 out of 8 patients with psychotic symptoms. CONCLUSION: Severe and prolonged combat trauma may be followed by the co-occurrence of PTSD and psychotic symptoms, forming the atypical clinical picture of PTSD.  (+info)

Influence of 1991-1995 war on breast-feeding in Croatia: questionnaire study. (34/803)

AIM: To investigate the influence of 1991-1995 war on the prevalence, duration, and practice of breast-feeding Croatian children up to 5 years of age. METHOD: In 1996, interviews were conducted in households with children up to 2 years of age (757 children) and 2-5 years of age (1,180 children). Data for war-free areas, war-affected areas, and areas liberated after several years of occupation were analyzed separately. RESULTS: In 1996, 94.6% of mothers started breast-feeding, which lasted for an average of 3.4+/-2.9 months. The proportion of mothers who started breast-feeding did not vary with respect to either war-related or geographic areas of the country. Breast-feeding was significantly longer in war-free than in war-affected areas (3.7+/-3.1 vs. 2.7+/-2.1 months, respectively; p=0.015). The duration of breast-feeding in Croatia's geographic regions, Istria, Hrvatsko Primorje, and Gorski Kotar, was significantly longer than in Slavonia (3.9+/-3.4 vs. 3.4+/-3.0, respectively; p=0.037). On the country level, 49.4% of babies were fed on demand and 43.3% according to a daily schedule. The percent of children who were not breast-fed was significantly higher (p=0. 002) in the older age group (2-5 years of age, 9.3%) than in the younger age group (up to 2 years of age, 5.4%). CONCLUSIONS: The war decreased the prevalence and duration of breast-feeding, which might be related to regular humanitarian donations of infant food and mother's milk substitutes, especially in the war-affected areas. UNICEF breast-feeding campaign, which started in 1993, appeared to be effective.  (+info)

A multivariate method for estimating mortality rates among children under 5 years from health and social indicators in Iraq. (35/803)

BACKGROUND: Many reports on Iraq suggest that a rise in rates of death and disease have occurred since the Gulf War of January/February 1991 and the economic sanctions that followed it. METHODS: Four preliminary models, based on unadjusted projections, were developed. A logistic regression model was then developed on the basis of six social variables in Iraq and comparable information from countries in the State of the World's Children report. Missing data were estimated for this model by a multiple imputation procedure. The final model depends on three socio-medical indicators: adult literacy, nutritional stunting of children under 5 years, and access to piped water. RESULTS: The model successfully predicted both the mortality rate in 1990, under stable conditions, and in 1991, following the Gulf War. For 1996, after 5 years of sanctions and prior to receipt of humanitarian food via the oil for food programme, this model shows mortality among children under 5 to have reached an estimated 87 per 1000, a rate last experienced more than 30 years ago. CONCLUSIONS: Accurate and timely estimates of mortality levels in developing countries are costly and require considerable methodological expertise. A rapid estimation technique like the one developed here may be a useful tool for quick and efficient estimation of mortality rates among under 5 year olds in countries where good mortality data are not routinely available. This is especially true for countries with complex humanitarian emergencies where information on mortality changes can guide interventions and the social stability to use standard demographic methods does not exist.  (+info)

Anesthesia in the Yom Kippur war. (36/803)

The role of the anesthetist in the treatment of battle casualties is discussed in the light of personal experience in a field hospital and in the rear during the Yom Kippur War of October 1973. Resuscitation and intensive care both before and after evacuation play an important part in reducing mortality, and the importance of providing adequate facilities for these functions in the battle area as well as at the base is emphasized.  (+info)

Cancer incidence and survival following bereavement. (37/803)

OBJECTIVES: This study investigated the effect of parental bereavement on cancer incidence and survival. METHODS: A cohort of 6284 Jewish Israelis who lost an adult son in the Yom Kippur War or in an accident between 1970 and 1977 was followed for 20 years. We compared the incidence of cancer in this cohort with that among nonbereaved members of the population by logistic regression analysis. The survival of bereaved parents with cancer was compared with that of matched controls with cancer. RESULTS: Increased incidence was found for lymphatic and hematopoietic malignancies among the parents of accident victims (odds ratio [OR] = 2.01; 95% confidence interval [CI] = 1.30, 3.11) and among war-bereaved parents (OR = 1.47; 95% CI = 1.13, 1.92), as well as for melanomas (OR = 4.62 [95% CI = 1.93, 11.06] and 1.71 [95% CI = 1.06, 2.76], respectively). Accident-bereaved parents also had an increased risk of respiratory cancer (OR = 1.50; 95% CI = 1.07, 2.11). The survival study showed that the risk of death was increased by bereavement if the cancer had been diagnosed before the loss, but not after. CONCLUSIONS: This study showed an effect of stress on the incidence of malignancies for selected sites and accelerated demise among parents bereaved following a diagnosis of cancer, but not among those bereaved before such a diagnosis.  (+info)

Self-reported postwar injuries among Gulf War veterans. (38/803)

OBJECTIVE: From September 1995 to May 1996, the authors conducted a telephone survey of Iowa military personnel who had served in the regular military or activated National Guard or Reserve during the Gulf War period. To assess the association between military service in a combat zone and subsequent traumatic injury requiring medical consultation, the authors analyzed veterans' interview responses. METHODS: Using data from the larger survey, the authors compared rates of self-reported postwar injuries requiring medical consultation in a sample of Iowa Gulf War veterans to the rates in a sample of Iowa military personnel who served at the same time, but not in the Persian Gulf. RESULTS: Of 3695 veterans, 605 (16%) reported a traumatic injury in the previous three months requiring medical consultation. Self-reported injuries were associated with service in the Persian Gulf (odds ratio 1.26; 95% confidence interval 1.02, 1.55). CONCLUSION: This finding is consistent with the results of earlier studies of traumatic injury mortality rates among war veterans.  (+info)

Post traumatic stress disorder with psychotic features. (39/803)

AIM: To study the combined course and interaction of post-traumatic stress disorder (PTSD) and psychosis through detailed case studies. METHODS: We described 6 case studies of Israeli veterans with PTSD and psychosis, who were referred to our Center for the evaluation of their psychiatric status. RESULTS: All the patients developed PTSD shortly after the exposure to a combat/military trauma. Psychosis appeared after months or even years, sometimes after a trauma-related trigger. Psychotic symptoms, such as delusions or auditory hallucinations, were usually paranoid or depressive and related in content to the traumatic experience. CONCLUSION: The combined course of PTSD and psychotic disorder may reflect two distinct disorders, but in some cases it seems justified to make a diagnosis of PTSD with psychotic features. In addition, it seems that in certain conditions, traumatic exposure and/or PTSD may serve as a trigger for psychosis.  (+info)

Psychiatric battle casualties: an intra- and interwar comparison. (40/803)

BACKGROUND: Psychiatric casualties are recognised as an important and inevitable feature of modern warfare. At the beginning of the 20th century they were scarcely acknowledged and still less treated. Today, as a result of lessons learned in the First and Second World Wars, numbers can be predicted on the basis of battle intensity and effective clinical interventions applied. AIMS: To discover more about the factors that cause psychiatric casualties and their relationship to total battle casualties. METHOD: A survey of historical War Office reports and the papers of Royal Army Medical Corps psychiatrists has provided both statistics and treatment strategies. RESULTS: Reported psychiatric casualties were low in the Boer War, influenced, in part, by the misdiagnosis of psychosomatic disorders. Their incidence rose appreciably in the First World War with the identification of shell-shock and neurasthenia. The Second World War saw the collection of accurate data, and combat stress was treated efficiently, although few soldiers returned to fighting units. CONCLUSIONS: A constant relationship exists between the incidence of the total killed and wounded and the number of psychiatric casualties, mediated by the nature of the fighting and quality of the troops involved.  (+info)