2017-2022 yılları arasında Meram Tıp Fakültesi adli tıp anabilim dalı tarafından 'zihinsel, ruhsal ve davranışsal bozukluklar' başlığı yönünden maluliyet raporu düzenlenen olguların değerlendirilmesi
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Tarih
2024
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Adli Tıp, travmatik bir olay neticesinde mağdur olan kişilerde ortaya çıkan fiziksel ve ruhsal kayıpların tıbbi sonuçlarını objektif bir bakış açısıyla değerlendirmektedir. Hukuki olarak, mağdurlarda oluşan bu zararın ortaya çıkarılması gerekmektedir. Medikolegal uygulamalarda zaman zaman ön plana alınmayan ruhsal etkilenmelerin de bu değerlendirmede önemi büyüktür. Bu çalışmada, maluliyet oranı tayini için başvuran ve psikiyatri uzman muayenesi için konsültasyona yönlendirilen olguların değerlendirilmesi, bu değerlendirme neticesinde elde edilen bulgularla ruhsal kayıplar yaşayan hastalara adli tıbbi yaklaşımda dikkat edilmesi ve geliştirilmesi gereken hususların tespiti amaçlanmıştır.
Yöntem: Necmettin Erbakan Üniversitesi Tıp Fakültesi Adli Tıp Anabilim Dalı’na Ocak 2017 – Aralık 2022 tarihleri arasında maluliyet raporu almak amacıyla başvuran ve psikiyatrik değerlendirmeye alınan olgular geriye dönük olarak düzenlenen maluliyet raporları aracılığıyla değerlendirilmiştir. Araştırma sonucu elde edilen veriler bilgisayar ortamında SPSS (Statistical Package for Social Sciences) 21.0 paket programı ile analiz edilmiştir.
Bulgular: Çalışmamıza 246 olgu dâhil edilmiştir. Yaş ortalaması 36,69±14,17 olarak bulunmuştur. Olguların 129’u erkek (%52,4), 117’si kadın (%47,6) cinsiyettedir. Olgularda travmanın kaynağı olarak en sık trafik kazası (n:230, %93,5) tespit edilmiştir. Trafik kazası türleri arasında en sık araç içi trafik kazası (n:123, %53,5) saptanmıştır. Olguların 147’sinde (%59,8) olaydan sonra maluliyete yol açan fiziksel sekel olduğu tespit edilmiştir. Olguların 150’sinde (%61,0) psikiyatrik açıdan değerlendirme sonrası maluliyet oranı tayini yapıldığı görülmüştür. Tanılar değerlendirildiğinde, 90 olguda (%36,6) TSSB, 36 olguda (%%14,6) depresif bozukluk ve 21 olguda (%8,5) anksiyete bozukluğu saptandığı anlaşılmıştır. Komorbidite açısından çoklu tanıların da çalışmamızda olduğu görüldü. Semptom kümelerinin sıklığına bakıldığında, bilişlerde-duygudurumda olumsuz değişiklikler (%60,4), artan uyarılmışlık (%54,2) ve kaçınma davranışları (%51,5) semptom kümelerinin sıklıkla tespit edildiği görüldü. Kadın olgularda psikiyatrik sekel kaynaklı maluliyet oranı varlığı istatistiksel olarak anlamlı yüksek saptandı (p=0,045). Kadın olgularda kaçınma ve bilişlerde duygu durumda olumsuz değişiklikler semptom kümeleri erkek olgulara göre istatistiksel olarak anlamlı yüksek bulundu (p değerleri sırasıyla; p<0,001, p=0,003).
Sonuç: Travma sonucu yaralanmış olgularda ruhsal kayıpların tespiti geciktirilmemeli ve göz ardı edilmemelidir. Ruhsal kayıplar, kişi ve toplum üzerinde önemli sonuçlara ve maliyetlere sebep olmaktadır. Mağdurlara olayın başından itibaren akut stres bozukluğu gelişimi açısından tarama uygulamalı, düzenli bir süreyle takiplerine devam edilmelidir. Yaralanma ağırlığı hafif olan olgularda da önemli oranda ruhsal patoloji gelişimi görülmekte olup, hekimlerin bu noktada ön yargı oluşturmaması gerekmektedir. Ortaya çıkan bulgular neticesinde, dünya üzerindeki örneklerin de incelenmesi ile objektif değerlendirme yapılabilmesi amacıyla tarama ve tanı ölçeklerinin hazırlanmasının hastanın sağlığına ve adli tıbbi süreçlere fayda sağlayacağını düşünmekteyiz. Maluliyet yönetmeliklerinde Ruh Sağlığı ve Hastalıkları başlığı açısından mevcut kısıtlı çerçevenin, oran tayini yaparken sağlıklı bir değerlendirme imkânı vermediği, bu nedenle yönetmeliklerin bu hususlarda gözden geçirilmesi gerektiği düşüncesindeyiz.
Objective: The Forensic Medicine evaluates the medical consequences of physical and psychological losses that occur in victims as a result of a traumatic event from an objective point of view. It is legally necessary to reveal this damage to the victims. Psychological effects which are sometimes not prioritized in medico-legal practices are very important in this evaluation. The aim of the present study was to evaluate the cases who applied for the determination of disability rate and were referred to consultation for psychiatry specialist examination, and to determine the issues that should be considered and developed in the forensic medical approach to patients with mental losses with the findings obtained as a result of this evaluation. Method: The individuals who have referred to Necmettin Erbakan University Faculty of Medicine, Department of Forensic Medicine between January 2017 and December 2022 in order to get a disability report and were psychiatrically assessed were evaluated retrospectively through the disability reports. The data obtained as a result of the research were analyzed with SPSS (Statistical Package for Social Sciences) 21.0 package program. Findings: Two hundred and forty-six patients were included in our study. The mean age was 36.69±14.17 years. One hundred and twenty-nine cases were male (52.4%) and one hundred seventeen were female (47.6%). The most common source of trauma was traffic accident (n:230, 93.5%). The most common type of traffic accident was in-vehicle traffic accident (n:123, 53.5%). It was determined that 147 (59,8%) cases had physical sequelae leading to disability after the incident. Disability rate was determined after psychiatric evaluation in 150 (61.0%) of the cases. The assessment of the diagnoses were assessed revealed that 90 cases (36.6%) had PTSD, 36 cases (14.6%) had depressive disorder and 21 cases (8.5%) had anxiety disorder. Multiple diagnoses in terms of comorbidity were also observed in our study. It was detected when the prevalence of symptom clusters was examined that negative changes in cognitions-mood (60.4%), increased arousal (54.2%) and avoidance behaviors (51.5%) were common. The presence of disability rate due to psychiatric sequelae was significantly higher in female patients (p=0,045). Avoidance and negative changes in cognitions-mood symptom clusters were significantly higher in female patients when compared to male patients (p values were p<0.001, p=0.003, respectively). Conclusion: Detection of psychological losses in traumatized patients should not be delayed or ignored. Psychological losses cause significant consequences and costs on the individual and society. The victims should be screened for development of acute stress disorder from the beginning of the incident and their follow-up should be continued on a regular basis. A significant rate of psychological pathology development is also observed in cases with mild injuries, and physicians should not make pre-judgements at this point. As a result of the findings, we consider that the preparation of screening and diagnostic scales in order to make objective evaluations by examining the examples in the world would be useful for the patient health and forensic medical processes. We are of the opinion that the limited framework in the disability regulations in terms of the title of Mental Health and Diseases does not provide a healthy evaluation when determining the rate, and therefore, the regulations should be revised in these matters.
Objective: The Forensic Medicine evaluates the medical consequences of physical and psychological losses that occur in victims as a result of a traumatic event from an objective point of view. It is legally necessary to reveal this damage to the victims. Psychological effects which are sometimes not prioritized in medico-legal practices are very important in this evaluation. The aim of the present study was to evaluate the cases who applied for the determination of disability rate and were referred to consultation for psychiatry specialist examination, and to determine the issues that should be considered and developed in the forensic medical approach to patients with mental losses with the findings obtained as a result of this evaluation. Method: The individuals who have referred to Necmettin Erbakan University Faculty of Medicine, Department of Forensic Medicine between January 2017 and December 2022 in order to get a disability report and were psychiatrically assessed were evaluated retrospectively through the disability reports. The data obtained as a result of the research were analyzed with SPSS (Statistical Package for Social Sciences) 21.0 package program. Findings: Two hundred and forty-six patients were included in our study. The mean age was 36.69±14.17 years. One hundred and twenty-nine cases were male (52.4%) and one hundred seventeen were female (47.6%). The most common source of trauma was traffic accident (n:230, 93.5%). The most common type of traffic accident was in-vehicle traffic accident (n:123, 53.5%). It was determined that 147 (59,8%) cases had physical sequelae leading to disability after the incident. Disability rate was determined after psychiatric evaluation in 150 (61.0%) of the cases. The assessment of the diagnoses were assessed revealed that 90 cases (36.6%) had PTSD, 36 cases (14.6%) had depressive disorder and 21 cases (8.5%) had anxiety disorder. Multiple diagnoses in terms of comorbidity were also observed in our study. It was detected when the prevalence of symptom clusters was examined that negative changes in cognitions-mood (60.4%), increased arousal (54.2%) and avoidance behaviors (51.5%) were common. The presence of disability rate due to psychiatric sequelae was significantly higher in female patients (p=0,045). Avoidance and negative changes in cognitions-mood symptom clusters were significantly higher in female patients when compared to male patients (p values were p<0.001, p=0.003, respectively). Conclusion: Detection of psychological losses in traumatized patients should not be delayed or ignored. Psychological losses cause significant consequences and costs on the individual and society. The victims should be screened for development of acute stress disorder from the beginning of the incident and their follow-up should be continued on a regular basis. A significant rate of psychological pathology development is also observed in cases with mild injuries, and physicians should not make pre-judgements at this point. As a result of the findings, we consider that the preparation of screening and diagnostic scales in order to make objective evaluations by examining the examples in the world would be useful for the patient health and forensic medical processes. We are of the opinion that the limited framework in the disability regulations in terms of the title of Mental Health and Diseases does not provide a healthy evaluation when determining the rate, and therefore, the regulations should be revised in these matters.
Açıklama
Anahtar Kelimeler
Adli Tıp, TSSB, ruhsal travma, maluliyet., Forensic Medicine, PTSD, mental trauma, disability.
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kara, A. (2024). 2017-2022 yılları arasında Meram Tıp Fakültesi adli tıp anabilim dalı tarafından 'zihinsel, ruhsal ve davranışsal bozukluklar' başlığı yönünden maluliyet raporu düzenlenen olguların değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Adli Tıp Anabilim Dalı, Konya.
