49J Contemp Med Sci | Vol. 2, No. 6, Spring 2016: 49–52 Research Objectives This study aims to estimate the rate of acute stress disorder (ASD) among burn patients. The sample consists of 100 patients admitted to burn unit in Al-Kindy Teaching Hospital in Baghdad city. There is a significant relationship between ASD and burn patients; it is the mean majority of patients with burn developed ASD. Methods A total of 100 patients are attended to burn unit in Al-Kindy Teaching Hospital in Baghdad city. DSM-IV criteria were applied. GHQ and socio demographic data were used for diagnosis. All the patients who do not meet the criteria were excluded from the sample by using ASD symptom questionnaire; proper consent was already taken from all patients. Results A total of 100 patients with ASD were identified in the burn unit, academic psychiatrists made diagnosis to evaluate the positive symptoms (positive symptoms scale). ASD represent 80% of all admissions and was more common among females than males, more than half of the cases were between 15 and 24 years of age with the mean age of 30 years. The majority of cases were married, and the mortality rate of burned patients was 69.4, and the median total body surface area (TBSA) burnt was 60%. 18.6% of patients had previous attempt for self-inflicted burn. Conclusion Both the disease process and treatment of burned patients may affect the mental state of patients producing a variety of symptoms. ASD is the most common psychiatric disorder in burned patients. There is a significant relationship between ASD and burned patients. Keywords burned patients, stress-related disorder, acute stress disorder, dissociation, early identification Psychosocial and medical patterns of acute stress disorder in burn unit in Baghdad, Iraq Abbas Saeed Al-Eessaa, Abdulmahdi A. Hasanb ISSN 2413-0516 aSpecialist, Psychiatrist in Marjan Teaching Hospital, Hilla City, Iraq. bDepartment of Paediatric and Psychiatric Mental Health Nursing, College of Nursing, University of Babylon, Hilla City, Iraq. Correspondence to Abbas Saeed Al-Eessa (email: drabbasaleessa@yahoo.com). (Submitted: 23 December 2015 – Revised version received: 27 February 2016 – Accepted: 1 April 2016 – Published online: 26 June 2016) Introduction Acute stress disorder (ASD) refers to an anxiety and disturbed behaviour that can occur in the time after an extreme trauma. The symptoms usually start during or soon after the trauma, but if the symptoms continue longer than a month, then the condition called pTSD.1–3 The signs and symptoms related to ASD includes sense of impending doom, nervousness, insta- bility tachycardia, hyperventilation, paraesthesia, diaphoresis, flushing, headache, and there are many causes and methods and behaviours of burn contribute to ASD. The cause of burn is variable and difficult, and the psychiatric morbidity between burned patients and ASD is believed to represent either pri- mary manifestations of the disease caused by skin involvement or psychological reaction to living with a disability and chronic illness.5–7 Materials and Methods A total of 100 patients were attended to burn unit in Al-Kindy Teaching Hospital in Baghdad city, DSM-IV criteria were applied for the diagnosis of persons with ASD, GHQ and sociodemographic data were used and applied for each person, and the aim was to know the targeting patients; all the patients who do not meet the criteria were excluded from the sample and the study was conducted by using ASD scale. Subjects and Sample A total of 100 patients with ASD were identified in the burn unit, academic psychiatrists made diagnosis to evaluate the positive symptoms (positive symptoms scale) was used. Statistical Analysis All the statistical analysis were performed using P-value and Chi-square test (χ2). The relations among the categorical vari- ables were investigated by χ2. P-value more than or equal to 0–0.5 were considered statistically significant. All the data were analysed by χ2 at a confidence level of 95%. The data were analysed using χ2 test for the differences between the groups. The odds ratio was computed for estimating the strength of association of the risk factors and the occurrence of the disease. If odds ratio equal to 1 or more means that there is a pos- itive association. If odds ratio less than one means, there is a protection against the occurrence of the disorder. After studying this table and the statistical data, we found there is a strong correlation between ASD and age groups, 35–54 more than other group. Table 7 shows that every patient in this group is free from ASD. Sociodemographic characteristics, gender and age of groups (P < 0.05) are shown in Tables 1–8, further no signifi- cant relationship was found among sociodemographic charac- teristics, and the prevalence of ASD was higher in female than in male in ASD of 89.8% (45), 65.8% (35), respectively. Table 8 shows that by analysing this table, we found the cor- relation is positive between the ASD and the severity of burn. Discussion In this study, the ratio of female to male patients is 3:2, which is slightly differing from the ratio recorded by other authors. There is a significant relation between female and male genders; in our 50 J Contemp Med Sci | Vol. 2, No. 6, Spring 2016: 49–52 Psychosocial and medical patterns of ASD Research Abbas Saeed Al-Eessa et al. Fig. 1 The ratio of female to male patients. Fig. 2 Significant relation between female sex married divorce, widow. Fig. 3 Significant relation between female sex married divorce, widow. Fig. 5 Close association between severity of burn injury and ASD. Table 1. Distribution of patients according to the burning agent Burning agent No. of patients and % Kerosene 46 Gas 40 Benzene 8 Hot fluid 3 Electricity 1 Other 2 (one is by hot iron bar and wielding oxygen the other case is unknown) Total 100 Table 2. Distribution of patients according to the cause of burn The cause No. of patients and % Accidental 82 Induced Attempted suicide Definite 10 Suspected 8 Criminal induced 0 study, we found that ASD is more common in females, and this difference could be due to the impact of life and bodily constitu- tion, and the male could be more denial than females, many studies found that mood disorders are common in burn unit,4,8,9,12 and the depression is the commonest that vary from 25 to 50% in our study; the commonest psychiatric morbidity in burn unit is ASD that was predominated in the patients with burn, and a close association between the severity of burn inju- ries and ASD was found. A significant relation between adult and middle age, female sex and widowed, married and divorced, unemployed. Significantly, a large number of the sample Table 3. Distribution of acute stress disorder cases in burn patients No. of patients and % Male Female Total Cases 27 53 80 Non cases 14 6 20 Total 41 59 100 Fig. 4 Close association between severity of burn injury and ASD. 51J Contemp Med Sci | Vol. 2, No. 6, Spring 2016: 49–52 Research Psychosocial and medical patterns of ASDAbbas Saeed Al-Eessa et al. presented from rural area. Also there is a low level of education and poverty which are the risk factor for accidents as burn and for ASD. Also, we have found a considerable number of patients in burn unit with attempted suicide either definite or suspected self-immolation among young Muslim women in parts of the Middle East and Central Asia, which is increasingly becoming a cause of death and disability, and very little is known about this phenomenon.13–16 Male victims generally predominate in western countries and females in the Middle East and the Indian sub-continent.15–17 In Jordan, burning by kerosene is a common traditional and dramatic way of attempting suicide by females. Sati was described as a custom in India, in which the widow was burnt to ashes on her dead husband. In view of the selected var- iables of our study, we have found high number of patients with ASD in the age between 15 and 24 years, this may be explained by difficult economic and social situations and burden.11,12 The females out-numbered males. This may be explained by the tendencies in females to have mental disturbances more than males.14,15 The high number of patients with ASD are in the group of married, divorced and widowed, which is because of each group has their own stress in their difficult socio-economic state and being responsible for many family demands. ASD was high in unemployed. This may be explained due their financial problems and lack of economic resources and social insecurity and their psychological effect of being without work.9 By stud- ying the result of severity of burn, we have found that ASD increases with the severity of burn, in moderate and severe burn, while we have less or no ASD in minor burns. Recommendations The patient with burn needs psychological assessment from beginning of disease and at regular intervals thereafter to deal with psychiatric morbidity. Liaison work between plastic sur- geon and psychiatrist is required for the management of the burned patients. Abbreviations ASD: acute stress disorder; GHQ: general health question- naire; DSM-IV diagnostic statistical of mental health disor- der-fourth version; TSAB: total surface area burnt; PTSD: post traumatic stress disorder.  Table 4. Distribution of patients according to age groups Age group Patients no. Cases no. % of the cases P-value χ2 Odd’s ratio 15–24 45 35 77.7 0.0631 0.78 25–34 25 21 84 0.12 1.42 35–44 16 14 87.5 1.01 1.9 45–54 8 8 100 3.063 E* 55 & above 6 2 33.3 7.32 0.102 Total 100 80 E* means that every patient burned in this age group is having acute stress disorder. Table 5. Distribution of patients according to sex difference Sex Patients Cases no. % of the cases P-value χ2 Odd’s ratio Male 41 27 65.8 8.593 0.218 Female 59 53 89.8 Total 100 80 Table 6. Acute stress disorder according to marital status Marital status Patients no. Cases no. % of the cases P-value χ2 Odd’s ratio Single 33 24 27.7 1.558 0.523 Married 59 49 83 0.705 1.58 Widowed 4 4 100 2.166 E* Divorced 4 3 75 0.291 0.74 Total 100 80 E* means every patient in this group is having ASD. Table 7. Distribution of patients with acute stress disorder according to an employment Employment Patients no. Cases no. % of the cases P-value χ2 Odd’s ratio Housewife 57 48 84.2 1.479 1.833 Self employed 26 20 76.9 0.213 0.778 Unemployed 11 10 90.9 1.435 2.714 Government employed 2 2 100 2.041 E* Pupils 4 0 0 . . . . . . Total 100 80 E* means every patient in this group is having ASD; . . . means every patient in this group of pupils is free from ASD. Table 8. Distribution of patients with acute stress disorder according to the severity of burn Burn severity Patients no. Cases no. % of the cases P-value χ2 Odd’s ratio Minor 2 0 0 . . . . . . 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