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Psychological sequelae

In the period between January 2001 and June 2003, Centre for Rehabilitation of Torture Victims - IAN Belgrade (CRTV IAN) has provided psychological assistance for over 2,500 clients, of which 1,058 have had detailed admission and diagnostic records, as a part of the overall psychological and psychiatric treatment. From the overall number of clients, 621 of them were victims of torture, whereas the remaining 437 were refugees or internally displaced persons who could not be qualified as torture victims but have nevertheless approached the centre because of serious psychic problems caused by other war and post-war stressors; some of them were also family members of torture victims.

General psychopathology was much more prominent in the group of clients - torture victims.

Over 60% of IAN CRTV clients from this study had currently diagnosed PTSD. The most frequent stressors not related to war usually referred to precarious material and financial conditions (about 55%), including the lack of basic existential needs (about 45%).

Table 1 shows that most clients requested assistance primarily due to psychic discomforts and problems.

Table 1. Type of health problems for which the clients requested assistance in CRTV IAN

 

Tortured (n=256)

Non-tortured (n=97)

n

%

n

%

Only somatic problems

28

10.94

16

16.50

Only psychic problems

124

48.44

54

55.67

Psychic + somatic problems

77

30.08

16

16.50

No health problems

27

10.54

11

11.39

The structured diagnostic interview for DSM-IV (SCID-I) was conducted with CRTV clients. About 60% of clients had more than one psychiatric diagnosis.

Table 2. Psychiatric diagnoses for CRTV clients established on the basis of SCID-I, by groups of diagnoses (only current diagnoses)

 

Tortured (n=220)

Non-tortured (n=81)

n

%

n

%

PTSD

136

61.8

48

59.3

Depressive disorders

79

36.7

32

40.5

Anxiety disorders

52

24.2

27

34.2

Somatophorm disorders

24

11.2

8

10.1

Alcohol abuse / dependency

29

13.5

6

7.6

Other disorders

13

6.0

8

10.1

Together with current posttraumatic stress disorder (diagnosed in 60% of clients), the most frequently established diagnosis was one of the depressive disorders (40%), two times less anxiety disorders (26,3%) and rarely the diagnosis of alcohol abuse, somatophorm and other disorders. There is a significant difference in alcohol abuse/dependency, which has been established twice as frequently in torture victims than in non-tortured individuals (Table 2).

Table 3. Comorbidity of PTSD and other psychiatric disorders

 

 

Tortured (n=208)

Non-tortured (n=73)

PTSD (n=132)

No PTSD (n=76)

PTSD (n=47)

No PTSD (n=26)

n

%

n

%

n

%

n

%

Depressive disorders

63

47.7

13

17.1

26

55.3

5

19.2

Anxiety disorders

37

28.0

13

17.1

19

40.4

8

30.8

Somatophorm disorders

17

12.9

6

7.9

4

8.5

4

15.4

Alcohol abuse / dependency

15

11.4

13

17.1

4

8.5

1

3.8

Other disorders

9

6.8

3

3.9

5

10.6

1

3.8

The difference in number is due to the fact that 12 torture victims and 8 non-tortured individuals do not have both tests, but only SCID-I or CAPS.

From the overall number of clients diagnosed with posttraumatic stress disorder, only 21,8% of torture victims and 19% of non-tortured have the isolated PTSD. The remainder of about 80% of clients with PTSD also have some of the combined current psychiatric disorders (Table 3). In both sub-groups the most frequent is the comorbidity of PTSD with some of the depressive disorders (current major depressive episode, dysthymic disorder and non-specific depressive disorder). Comorbidity with anxiety disorders is somewhat more frequent in non-tortured individuals, while the comorbidity of alcohol abuse occurs more often in torture victims.

A large number of clients have been diagnosed with a medical (somatic or psychiatric) disorder for the first time during treatment in CRTV. Although CRTV offers general medical and psychological-psychiatric assistance, the focus of work was on the latter, for which CRTV had adequate material and human resources since the very beginning. The number of torture victims with combined psychic and somatic problems was significantly higher than the number non-tortured individuals with such problems, which could be explained on one hand by the direct adverse effect of captivity and torture on physical health, and on the other by indirect adverse effect of the prolonged psychic trauma (chronic PTSD) on somatic health.

Although there are no statistically significant differences in frequency of PTSD among these groups, torture victims do have a more intensive symptomatology, especially in clusters of extreme anxiety symptoms, which is in accordance with available results of most surveys conducted so far.

In another IAN CRTV study conducted with medical center MEDIAN we have involved those CRTV clients who have complained about somatic health related problems, and who have been referred to MEDIAN upon primary screening by IAN psychiatrists and psychologists. We have also included victims of torture from refugee camps covered by MEDIAN physicians during their field visits. The diagnosis was set on the basis of available medical documentation, anamnesis, physical examination and additional necessary diagnostic methods (ECG, ultrasound of the heart, physical burdening test, Holter ECG monitoring, EEG).

The project has encompassed 730 patients (355 men and 375 women), with average of 54▒11 years of age.

In 63% of the cases cardiovascular diseases were established as the primary diagnosis, of which 82% of patients were diagnosed with arterial hypertension and 5.2% with coronary diseases. The second most frequent group of disorders were those of endocrine glands (11.8%), of which 67.4% of patients were diagnosed with diabetes mellitus. CRTV clients represent a population with high risk of developing somatic disorders.

Torture survivors are at greater risk of somatic and especially psychiatric disorders. Their health problems last longer and carry a higher risk of becoming chronic.

You can find out more about profiles of our clients at The Socio-demographic and Psychiatric Profiles of Clients in the Centre for Rehabilitation of Torture Victims - IAN Belgrade and at Somatic Disorders of Clients in the Centre for Rehabilitation of Torture Victims: The One-Year Experience of "MEDIAN", and specially about forcibly mobilized refugees at Psychological Profile of Forcibly Mobilized Persons.

 

 


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