ABSTRACT
AIM: To explore possible causative factors in the development of post-traumatic stress disorder (PTSD) in disabled Croatian war veterans. METHOD: The sample comprised 42 disabled Croatian war veterans, aged 19 to 44 years, accommodated in the VaraZdinske Toplice Rehabilitation Hospital for the purpose of long-term physical rehabilitation. Manifestation of PTSD symptoms (Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder) and anxiety levels (Spilberger's State Trait Anxiety Inventory) were tested in 1994 and 1999. RESULTS: Patients with PTSD symptoms had significantly higher anxiety levels then patients without PTSD symptoms. The percentage of patients manifesting PTSD increased from 19% in 1994 to 41% in 1999. Over the same period, the anxiety levels decreased in the patients with PTSD. CONCLUSION: Anxiety and PTSD seem to share common etiologic grounds. Nevertheless, staying in the same homogenous group for a substantial period of time, in combination with inadequate social support and deficient psychological care, may contribute to the development of the PTSD symptomatology.
Subject(s)
Rehabilitation Centers/statistics & numerical data , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Warfare , Wounds and Injuries/rehabilitation , Adult , Age Distribution , Anxiety/diagnosis , Anxiety/epidemiology , Cohort Studies , Croatia/epidemiology , Disabled Persons/psychology , Humans , Incidence , Length of Stay , Male , Probability , Risk Factors , Sampling Studies , Statistics, Nonparametric , Time Factors , Veterans , Wounds and Injuries/psychologyABSTRACT
Countertransference in therapists working with patients with posttraumatic stress disorder (PTSD) differs from countertransference in other psychotherapeutical settings. In this article we discuss the specificities of counter- transference in treating PTSD patients and its relation to empathy. The most difficult countertransference problems occur in treating multiply traumatized patients. Countertransference may occur towards an event (e.g., war), patients who have killed people, as well as to colleagues who avoid treating PTSD patients, or towards a supervisor who avoids, either directly or indirectly, supervision of therapists working with PTSD patients. Our recommendation for the prevention of problems in treating PTSD patients include : 1) careful selection of the therapist or helper, both in the personality structure and training; 2) prevention by debriefing and team work and peer supervision; and 3) education - theoretical, practical, and therapeutical.
Subject(s)
Countertransference , Empathy , Physician Assistants/psychology , Physician-Patient Relations , Physicians/psychology , Psychoanalytic Therapy/standards , Stress Disorders, Post-Traumatic/psychology , Croatia , Defense Mechanisms , Humans , Multiple Trauma/complications , Multiple Trauma/psychology , Psychoanalytic Therapy/methods , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , WarfareABSTRACT
Working with psychotraumatized war veterans we perceived their extremely regressive position, which is accompanied by several destructive and autodestructive compulsions. Facing the multiple traumatic experiences which they lived through, a certain degree of regression has been appearing, since even a satisfying "nourishing-indulgence of their needs" cannot completely make up for their pre-war position. In this way occurred the splitting between ideal (introjected) object and real object, in which were projected all bad experiences, and which is still persecuting and wants to destroy. Through interactions between all group members of traumatized patients we analyzed the phenomena and the specificities of these groups-particularly their regressive position. The aim of the group psychotherapy was to enable progressive overcoming of regressive position and transition into a more mature stage of development, thus creating a favorable climate for growing up and independence.
Subject(s)
Psychotherapy, Group , Stress Disorders, Post-Traumatic/therapy , Warfare , Combat Disorders/psychology , Combat Disorders/therapy , Croatia , Female , Humans , Male , Stress Disorders, Post-Traumatic/psychologyABSTRACT
In order to determine the influence of anxiety on the development of BMT complications and survival, we analysed data on 35 consecutive patients undergoing BMT in our Centre between June 1992 and December 1994. All patients received bone marrow from HLA-identical MLC non-responsive siblings. For GVHD prophylaxis, all patients received cyclosporin (CsA) and short methotrexate (MTX). The diagnosis and severity of acute GVHD were defined according to the Seattle Transplant Team criteria. The patients were tested with the Spielberger STAI test as a measure of anxiety as a state (STAI-S) and as a trait (STAI-T). The STAI-S/1 and STAI-T/1 were performed during the first week of isolation (day -5 to day -3 prior BMT) and STAI-S/2 and STAI-T/2 at the end of the discharge from laminar air flow units (day +35 to day +40 post-transplant). During isolation all patients had daily psychiatric support. Out of 35 patients, 31 (89%) fulfilled the STAI-S and STAI-T during the first week and at discharge from laminar air flow isolation. The level of anxiety at the beginning of isolation as measured by STAI-S/1 and STAI-T/1 tests had been significantly higher in patients who subsequently developed acute grade II-IV GVHD as compared to patients with GVHD grade 0-I (P < 0.001), irrespective of age, sex or stage of the disease prior to BMT. In those patients who died, the STAI-S/1, STAI-T/1 and STAI-T/2 tests had been almost identical to those of surviving patients, while STAI-S/2 had been significantly higher (P = 0.034). These data clearly indicate an association between the level of anxiety and the risk for BMT complications, but this should be confirmed in further controlled clinical trials.
Subject(s)
Anxiety/complications , Bone Marrow Transplantation/adverse effects , Graft vs Host Disease/etiology , Adolescent , Adult , Bone Marrow Transplantation/psychology , CD8-Positive T-Lymphocytes/immunology , Female , Humans , Male , Middle AgedABSTRACT
The present study was carried out in the Popovaca Psychiatric Hospital and the examinees were nurses (N = 44) allocated to educative work in Balint groups. Authors discuss if any change may occur in the attitude towards some relevant notions during the one-year educative work in Balint groups. A graphic form of semantic differential was used as the measuring instrument. The findings of this study suggest that during the educational process the attitude towards notions "education", "doctor" and "myself" becomes more negative. The attitude towards the notion "patient" remains unchanged.
Subject(s)
Attitude of Health Personnel , Psychiatric Nursing , Psychoanalytic Therapy , Adult , Humans , Semantic DifferentialABSTRACT
The paper gives an introduction to the superego in patients' dreams in group analysis and presents new contributions to the theory of the superego. The following aspects are dealt with in more detail: the superego as resistance to change, the superego in the group, the dream is the group--the group is the dream, uncovering the superego in a group member's dream, possibilities of therapeutic action on the superego in the group, working with a member's dream in the group, countertransference reactions to "superego-dreams" in the group and the therapeutic effect of the "superego-dream" analysis in the group.
