ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Modirian   E. (1)
Mousavi   S.J. (1)
Mousavi   B. (1)
Soroush   M. (1)
Khateri   Sh. (1)
Hosseini   M. (1)
Mokhber   N. (*)






(*) Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
(1) Janbazan Medical and Engineering Research Center (JMERC), , Tehran, Iran

Correspondence

Address: No. 17, Farrokh Street, Moghaddas Ardebily Avenue., Chamran Highway, Tehran, Iran
Phone: +982122416699
Fax: +982122412502
nmokhber@yahoo.com

Article History

Received:  April  7, 2015
Accepted:  May 13, 2015
ePublished:  August 25, 2015

BRIEF TEXT


… [1-3] 60.7% of the Iranian chemically injured veterans are with ocular injuries caused by mustard gas [4], of whom 35%, 3.6%, and 0.7% are with mild, moderate, and severe symptoms of ocular injuries, respectively. … [5-13]

Veterans with chemical injuries are in the risk of PTSD [14]. Psychosis, anxiety, hypochondriasis, sleep quality, and depression of the veterans with chemical injuries have been studied [15-18].

The aim of this study was to diagnose the types of the prevalent psychiatric disorders in veterans with ocular chemical injuries.

This is a cross sectional study.

Veterans with severe ocular injuries caused by mustard sulfur of Mashhad (Iran) were studied in 2010.

148 veterans were met through public calls.

Through a 20-minute interview, the veterans were visited by a psychiatrist, and appearances were investigated, which were general appearance, mood, emotion, speech, perception, illusions, thinking, content of thinking, navigation, short-term memory, long-term memory, judgment, insight, and reliability. All veterans were visited by a psychiatrist, using DMS-IV Form. The form has a 5-axis system. Axis 1 introduces the type of psychological disorder. Axis 2 investigates the presence of characteristics disorders and mental retardation. Axis 3 investigates any type of disorders or physical status that can lead to psychiatric disorders. Axis 4 investigates the recent psychiatric stresses. Axis 5 investigates the subjects’ efficiency level during the study. Using a 10-scale scoring, the subject’s activity level is identified from 1-10 scores (persistent inability to maintain personal hygiene and constant danger of harming themselves and others) to 91-100 scores (completely able to perform personal activities individually) [19]. Data was analyzed, using SPSS 22 software. Pearson Correlation Coefficient and Chi-square tests were used to investigate any correlation between demographic characteristics and results of DSM-IV questionnaire such as psychological disorders.

One female person (0.7%) and 147 male persons (99.3%) were studied. Mean age was 44.87±8.73years (aged between 21 and 75years). More than a half of the subjects (53.7%) aged between 40 and 49years. Except 2 persons (1.3%), the remaining subjects were married. 98 persons (66.2%), 36 persons (24.3%), and 14 persons (9.5%) had faced to chemical materials once, twice, and between 2 and 6 times, respectively (Table 1). 88 persons (59.5%) out-patiently visited by the psychiatrists, and 15 persons (10.1%) were formerly hospitalized in a psychiatric hospital. Un-natural emotion, depression, and irritability were observed in 92 persons (62.2%), 62 persons (41.9%), and 61 persons (41.2%), respectively. There were natural judgment, insight, and reliability in all the veterans (100%). 8 subjects were with auditory hallucinations. 1 subject was with auditory-visual hallucinations (Table 2). There were 86 persons (58.1%) with different types of psychiatric disorders (axis 1). There were 50 persons (33.8%) and 45 persons (30.4%) with stress and anxiety disorders and different types of depression problems, respectively. And there were veterans with both problems. The most prevalent anxiety problem was PTSD in 22 persons (14.9%). The most frequent depression disorder was dysthymia in 17 persons (11.5%). There were 3 persons with dementia. In axis 2, 1 person (0.7%) was positive and was with schizophrenia. No veteran was with mental retardation. Axis 3 was considered positive for all the veterans, because all of them were with severe ocular disorders due to sulfur mustard. In axis 4, different problems were emphasized by the persons, which were classified in different groups concerning highly dispersed psychiatric stress causes. These were as follows: 13 persons with family problems (8.8%), 6 persons with economic problems (4.1%), 6 persons with deterioration of physical problems (4.1%), and 2 persons with job and occupation problems (1.3%). In axis 5, less than a half of the veterans were normal and able to do their own personal works solely, while other persons showed some dependence. Psychiatric disorders were diagnosed only in 68 persons of the veterans who formerly referred to the psychiatric centers. 27 persons (18.2%), 30 persons (20.3%), 9 persons (6.1%), 1 person (0.7%), and 1 person (0.7%) were with anxiety disorders, depression, anxiety and depression disorder, dementia, and dementia and anxiety, respectively. The treatment plan was as the followings: 10 persons (6.7%) were advised to continue the previous treatment, 57 persons (38.5%) needed to change the medication therapy, 1 person (0.7%) needed to hospitalize in a psychiatric hospital, and 20 persons (13.5%) had no longer need for any treatment. From 60 veterans who had not referred to a psychiatrist up to the study time, 18 persons (12%) were declared as new patients and 10 persons (6.8%), 6 persons (4.1%), 1 person (0.7%), and 1 person (0.7%) were with anxiety, depression, characteristic disorder, and both dementia and depression, respectively. The most prevalent anxiety problem was adaptation disorder in 6 persons (4.1%). Treatment plan for 12 persons (8.1%) included the start of medication therapy. The plan for 6 persons (4.1%) included the psychotherapy courses. There was a significant correlation between number of children and type of the psychiatric disorder. However, there were no significant correlation between age, injury percentage, education level, and attendant injury.

There is a higher statistical level of psychiatric disorders in persons who have facing a war. Nevertheless, there was a higher level of psychiatric disorders in chemically injured persons with severe ocular injuries than other veterans [8]. The adaptation level of physical veterans with any type of stresses was up to 35% higher than the chemical veterans [20]. The level of PTSD in non-chemical veterans is 30% lower than the chemical veterans [14]. The most prevalent characteristics observed on the appearances of the ocular-chemical veterans were depression and irritability. Hypochondriasis and panic are the most prevalent problems in the chemically injured veterans [15]. Depression is the most prevalent disorder in the veterans with chemical injuries [18]. Dysthymia frequency was 11.5%. The frequency of the disorder in Iranian population is 1.3%, which shows about 9 times than chemically injured veterans [21]. In axis 5, less than 50% of the veterans received the highest score, and they were able to do their own activities solely. Inability to do daily activities is one of the causes of high psychiatric problems in non-chemical veterans and other special groups such as the elderly [22-24]. There was a significant correlation between the number of children and type of the psychiatric disorder. Depression frequency in boys with weak relationships with their fathers who are veterans is hugely more than others, and there are weaker relationships between veterans with ocular injuries and their sons [25].

The effects of gender on psychiatric health, as well as psychiatric health of the families of chemically injured veterans with severe ocular injuries, should be studied.

More than 99% of the subjects were male. Therefore, gender was eliminated in any classification.

Identifying 18 new patients who need medication and psychiatric therapy, the present study shows that the veterans with ocular injuries need regular periodic cares. In addition, only a limited number of the former patients have been advised to continue the treatment, and most of them have needed changes in the treatment methods, and this case emphasizes psychiatric follow up in the veterans. Despite the fact that there were many difficulties to come together the veterans with ocular injuries from all Iranian cities in Mashhad, the results shows that the veterans need more attention and consecutive cares. Very high statistical levels of psychiatric problems which in some cases reach up to 9 times the Iranian society and about 2 times the non-chemically injured veterans confirm the peril of the group and more attention to the ocular-chemical veterans.

Mashhad Martyrs and Veterans Foundation and Janbazan Medical and Engineering Research Center (JMERC) are appreciated.

Non-declared

All the subjects participated voluntarily. The information kept secretly.

The study was funded by JMERC.

TABLES and CHARTS

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CITIATION LINKS

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