Acil Servise Başvuran Adli Olgularda Psikiyatrik Tany Birlikteliğinin ve Madde Kullanımının Geriye Dönük Değerlendirmesi

A Retrospective Evaluation of Psychiatric Comorbidity and Substance Use in Forensic Cases Admitted to Emergency Service

Özet

Giri? ve amaç: Adli olgular acil servislerde syk kar?yla?ylanve hukuki sorumlulu?u olan vakalardyr. Dü?ük sosyoekonomik durum ve gelir düzeyinin yanynda psikoaktifmadde ve alkol kullanymy, ki?ilik bozukluklary, bazy birincieksen bozukluklar gibi psikiyatrik tanylaryn ?iddet içeriklidavrany?lary artyrabildi?i bildirilmi?tir. Bu retrospektifçaly?mada adli olgularda madde kullanymy ve psikiyatriktany birlikteli?ini inceledik. Gereç ve Yöntem: Ocak 2012- Nisan 2014 tarihleri arasynda Van Asker Hastanesi acilservisine ba?vuran ve adli rapor düzenlenen 18 ya?üzerinde eri?kin hastalar çaly?maya dahil edildi.Geriyedönük olarak adli raporlaryna ek olarak hastane bilgi sisteminden sosyodemografik özelliklerine ve psikiyatriköykülerine ula?yldy. Bulgular: Hastalaryn 104'ünde(%23,6) psikiyatrik öykü mevcuttu. Psikiyatrik öyküsüolan ve olmayan hasta gruplary arasynda travma yaralanma ?iddet skoru açysyndan anlamly fark yoktu(p=0.06).Ensyk saptanan psikiyatrik tanylar uyum bozuklu?u ve Bkümesi ki?ilik bozuklu?u olarak tespit edildi. Psikiyatriköyküsü bulunan hastalarda en syk ba?vuru nedenleri darp(%52.9), zehirlenme (%26) ve ate?li silah/kesici delici aletyaralanmasy (%17.3) olup, darp ve zehirlenme anlamlydüzeyde yüksek saptandy(p<0.05). B kümesi ki?ilikbozuklu?u olan bireylerde darp, ate?li silah/delici kesicialet yaralanmasy ve zehirlenmenin anlamly düzeyde fazlaoldu?u saptanmy?ken, anksiyete bozuklu?u olan gruptazehirlenmenin anlamly olarak daha fazla oldu?u tespitedildi(p<0.05). Psikiyatrik öyküsü bulunan hastalaryn46'synda (% 44,2) madde kullanymy saptanmy? olup bugrupta madde kullanymy ile ate?li silah/kesici delici aletyaralanmasy arasynda anlamly düzeyde ili?ki saptanmy?tyr(p=0.03). Sonuç: Psikiyatrik tany birlikteli?inin vepsikoaktif madde kullanymynyn ara?tyrylarak takip vetedavisinin, adli olaylaryn meydana gelmesinde azaltycybir etki yarataca?y kanaatindeyiz.

Abstract

Objectives: Forensic cases are commonly encounteredcases with high legal responsibility. In addition to lowsocio-economic status and level of income, psychiatricdiagnoses such as substance and alcohol abuse, personality disorders, some axis 1 disorders have been reportedto increase violent behavior. In this retrospective study,we evaluated substance abuse, psychiatric comorbidity,and relationship between type of forensic report andpsychiatric diagnoses in forensic cases. Methods: Dataregarding sociodemographic characteristics, forensic circumstances and psychiatric history of forensic casesadmitted to Van Military Hospital Department ofEmergency between January 2012-April 2014 recruitedfrom hospital database. Results: One hundred andfour(23.6%) of the 441 patients had a psychiatric history. There was no significant difference in terms of injuryseverity score between the group with psychiatric diagnose history and the group with no psychiatric history(p=0.06). Adjustment disorder and B cluster personality disorder were the most prevalent psychiatric diagnoses in study population. Assault(52.9%), intoxication(26%) and firearm/sharp object injuy (17.3%) werethe most encountered forensic circumstances in thosewith psychiatric history as assault and intoxication werefound to be significantly higher than other events in thispopulation(p<0.05). Assessment of relationshipbetween type of forensic event and psychiatric diagnoses showed assault, firearm/sharp object injuy, andintoxication were statistically significant in B cluster disorder patients while intoxication was found to be significant in anxiety diagnosed patients(p<0.05). Substanceuse was determined in fourty-six patients(44.2%) ofthose with psychiatric history while a significant relationship was found between substance use andfirearm/sharp object injuy in this population(p=0.03).Conclusion: Detailed evaluation of psychiatric comorbidity and substance use with appropriate psychiatrictherapeutic interventions could have a positive impacton management of forensic cases.