Bipolar tip I bozukluk hastalarında kişilik bozukluğu eş tanısının hastalığın gidişine etkileri
Amaç: Bir kişilik bozukluğu (KB) olan ve herhangi bir KB olmayan bipolar tip I bozukluğu (BP-I) hastalarının hastalık özellikleri, hastalığın gidişi, intihar riski, alkol ve madde kullanımı gibi değişkenler açısından karşılaştırılması plan- lanmıştır. Yöntem: Kesitsel desendeki bu çalışmaya, DSM-IV-TR’e göre BP-I tanısıyla izlenen ve gönüllü onamı alınan 99 hasta alınmıştır. Katılımcılara Sosyodemografik Veri Formu, Hamilton Depresyon Ölçeği, Young Mani Ölçeği ve DSM-IV-TR-SCID-II yönergesi uygulandı. Bulgular: BP-I bozukluk hastalarının 38’inde (%38.4) en az bir KB saptandı. Hastalarda en fazla histriyonik KB (%18) bulundu. Katılımcıların %21.2’sinde iki çeşit KB, %6.1’inde üç çeşit KB saptandı. Birden fazla KB olan ve KB olmayan BP-I hastalar klinik özellikler açısından karşılaştırıldığın- da, KB olmayan hastalarda ortalama yatış süresi ve toplam manik atak sayısı yüksekken, toplam depresif atak sayı- sı düşük bulundu. Birden fazla KB olan hastalarda atipik depresyon görülme, intihar girişiminde bulunma ve alkol- madde kullanma oranları, KB olmayan gruptan istatistiksel olarak yüksek bulundu. Tartışma: Birden fazla KB olan BP-I hastaları KB olmayanlara göre daha fazla depresif atak geçirmeleri, ayrıca bu atakların atipik özellikli olması, daha çok alkol/madde kullanmaları ve daha çok intihar etme oranları göz önünde bulundurularak dikkatle izlenmesi gereken özel bir alt grup olarak ele alınmalıdır. Ayrıca bu hastaların daha düşük oranda hastanede kalma süreleri de tedaviyi tamamlayamama lehine yorumlanarak izlemelerinde ayaktan tedavinin daha ön planda olmasına özen gösterilmesi gerekebilir. (Anadolu Psikiyatri Derg 2019; 20(3):237-244)
Effects of comorbid personality disorders in bipolar type I disorder patients to disease course
Objective: It was planned to compare bipolar I patients (BP-I) with personality disorder (PD) and without anypersonality disorder in terms of variables such as disease characteristics, disease course, suicide risk, alcohol andsubstance use. Methods: This cross-sectional study 99 patients with BP-0I according to DSM-IV TR and gave toinformed consent were included. Sociodemographic Data Form, Hamilton Depression Scale, Young Mania Scale,and DSM-IV-TR-SCID-II were administered to participants. Results: At least one PD was detected in 38 (38.4%)patients with BP-I. Histrionic type (18%) PD was the most common in patients. Two types of PD were found in21.2% and three types of PD were found in 6.1% of the participants. In patients without personality disorder, themean number of hospitalizations and the total number of manic episodes were high while the total number of de-pressive episodes was low. The incidence of atypical depression, attempted suicide, and alcohol-substance abusewere statistically higher in patients with multiple PD than non-PD group. Conclusion: BP-I patients with multiplePD have more depressive episodes than non-PD patients; this group of patients should be considered as a specialsubgroup that should be followed carefully because of the atypical nature of these attacks, more suicide rates andthe use of more alcohol and substance. In addition, these patients lower hospitalization times may need to beinterpreted in favor of not being able to complete the treatment. For this reason, it may be important to monitorthese patients outpatiently. (Anatolian Journal of Psychiatry 2019; 20(3):237-244)
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