Tonguç Demir BERKOL, Simge KIRLIOĞLU SEREN, Yasin Hasan BALCIOĞLU, Neşe ÜSTÜN, Serkan İSLAM, İlker ÖZYILDIRIM

Comparison of sociodemographic and clinical characteristics of bipolar patients with and without seasonal patterns

Amaç: Bipolar bozukluk (BB), çoklu etiyolojiye sahip, dünya genelinde nüfusun %1-4'ünü etkileyen, %20-30 oranında mevsimsel gidiş gösterebilen psikiyatrik bir bozukluktur. Türkiye'de BB'de mevsimsel gidişin sıklığını, sosyodemografik ve klinik özelliklerle ilişkisini ve tedaviye etkilerini değerlendiren çalışma sayısı azdır. Yöntem: Çalışmaya, DSM-IV'e göre BB tanısı konmuş, iyilik dönemindeki 174 hasta alınmıştır. Eşlik eden psikiyatrik tanıları SCID-I ile belirlenmiştir. Çalışmamız, 'duygudurum izleme grafiği' ve sosyodemografik ve klinik özellikleri değerlendiren yarı yapılandırılmış görüşme çizelgesi doldurularak geriye dönük olarak yapılmıştır. Mevsimsellik, hastanın tüm dönemlerinin en az %75'inin aynı dönem tipi için aynı mevsimde ortaya çıkması olarak tanımlanmıştır. Hastalar, mevsimsel gidiş özelliği olanlar ve olmayanlar olarak iki gruba ayrılmıştır. Bulgular: Çalışmaya alınan hastaların %36.2'sinin mevsimsel özellik gösterdiği saptanmıştır. İlk dönem tip ayırt etmeden incelendiğinde, mevsimsellik göstermeyen grupta anlamlı düzeyde daha sık olduğu, ilk dönem tipi karşılaştırıldığında manik tipin mevsimsellik gösteren grupta, depresif tipin ise mevsimselliği olmayan grupta anlamlı düzeyde daha sık olduğu gözlenmiştir. Ayrıca ek tanısı başka türlü adlandırılamayan anksiyete bozukluğu ve distimi olanların, mevsimsellik gösteren grupta, hastanede yatmış olanların ise mevsimsellik göstermeyen grupta anlamlı düzeyde yüksek olduğu saptanmıştır. Lityum monoterapisine yanıt oranı, ortalama hastalık süresi, toplam geçirilmiş dönem sayısı ortalaması ve toplam karma dönem sayısı ortalaması, mevsimsellik gösteren grupta anlamlı düzeyde yüksek bulunmuştur. Sonuç: Ortalama hastalık süresi, toplam geçirilmiş dönem sayısı ortalaması ve toplam karma dönem sayısı ortalaması, mevsimselliği olan grupta anlamlı düzeyde yüksek bulunmuştur. Eksen-I ek tanılarından distimi oranı mevsimsel gidiş özelliği olan grupta anlamlı düzeyde daha yüksek saptanmıştır. Bu bulgu mevsimsel özellikli olanların depresif özelliklerinin daha fazla olduğunu göstermektedir. Tüm bu bulgular bize mevsimsel özellikli hastaların prognozlarının daha kötü olduğunu göstermektedir. Diğer bulgu, mevsimsellik ile lityum korumasına olumlu yanıtın ilişkili olduğudur. Mevsimsel özelliği olan grubun ilk dönemde görülmesi, mevsimsel özelliği olmayan gruba göre anlamlı bulunmuştur. BB'nin ilk olarak sıklıkla depresif dönem şeklinde olarak başladığı bilinmektedir. Bu bulguların mevsimsellik için ön belirteç olabileceğini düşündürmektedir.

Bipolar bozuklukta mevsimselliği olan ve olmayan hastaların sosyodemografik ve klinik özelliklerinin karşılaştırılması

Objective: Bipolar disorder (BD) affects 1-4% of the population worldwide and presents with seasonal patterns with an incidence of 20-30%. Limited studies exist on seasonality, its relation to sociodemographic and clinical characteristics, and effects on treatment in BD in Turkey. Methods: This retrospective study included 174 patients with a major diagnosis of BD according to the DSM-IV. Comorbidities were determined using the SCID-I. The study was conducted using a semi-structured interview schedule and a mood monitoring chart. The patients were divided into two groups, those with and those without seasonal patterns, and their sociodemographic and clinical characteristics were compared. Results: We found that 36.2% of patients with BD had seasonal patterns. Regardless of type, first episodes were significantly more frequent in the nonseasonal group. With respect to first-episode types, the manic type was significantly more frequent in the seasonal group and the depressive type in the nonseasonal group. The number of patients with a comorbid anxiety disorder (NOS) or dysthymia was significantly higher in the seasonal group and the hospitalized nonseasonal group. The rate of response to lithium monotherapy, mean duration of the disease, mean total number of episodes, and mean total number of mixed episodes were significantly higher in the seasonal group. Conclusion: The rate of dysthymia was significantly higher in the seasonal group, suggesting that those with seasonality have more depressive aspects. These results indicate that the prognosis for seasonal bipolar patients is poorer than for nonseasonal patients. Another important finding was the presence of a correlation between seasonality and a positive response to lithium protection. It has been established that the first episode of the disorder was manifested in the seasonal pattern. The first episode of BD is known to often develop as a depressive episode. These results suggest that it may be a predictor of seasonality.

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