Dirençli obsesif kompulsif bozukluk ve tedavi seçenekleri

Obsesif kompulsif bozukluk obsesyonlar ve/veya kompulsiyonlarla belirli, yeti yitimine neden olan ve yaşam kalite-sini bozan bir anksiyete bozukluğudur. Kronik gidişli ve yineleyici özellikler gösterir. Dirençli hastaların oranı göre-ce yüksektir. Direnç, en az herhangi iki serotonin gerialım inhibitörü veya iki farklı gruptan antidepresanın veya biri klomipramin olmak üzere en az iki serotonin gerialım inhibitörünün maksimum dozda ve yeterli süre kullanılması-na karşın yanıt alınamaması olarak tanımlanır. Obsesif kompulsif bozukluğun ilk seçenek ilaç tedavisine yanıt oranı %40-60 arasındadır. Dirençli hastalarda tanı, önceki tedaviler, tedaviye uyum, komorbidite dikkatli değerlen-dirilmelidir. Tedavi seçenekleri ilacı değiştirmeyi, bilişsel davranışçı tedavi eklemeyi, iki serotonin gerialım inhibitö-rünün kombinasyonunu, damar içi serotonin gerialım inhibitörlerini (klomipramin, sitalopram), güçlendirme tedavi-lerini (diğer antidepresanlar, antipsikotikler, duygudurum düzenleyiciler, glutamaterjik ajanlar, benzodiyazepinler), alternatif monoterapileri (MAOİ'leri, venlafaksin, sumatriptan, glutamaterjik ajanlar, psikostimulanlar, buspiron, tramodol) kapsar. İlaç tedavisi dışında diğer tedavi seçenekleri bilişsel davranışçı tedavi, elektrokonvulzif tedavi, transkraniyal manyetik uyarım, derin beyin uyarımıdır. Psikoşirürji, hiçbir tedaviye yanıt vermeyen dirençli hasta-larda son seçenektir. İlaç tedavisi ve bilişsel davranışçı tedavi dışındaki seçeneklerin yararı kesin değildir.

Resistant obsessive compulsive disorder and treatment alternatives

Obsessive compulsive disorder is an anxiety disorder that is characterized with obssessions and/or compulsions, causes disability, and impairs the quality of life. It has chronic course and a recurrent characteristic. The ratio of patients with resistant obsessive compulsive disorder is relatively high. Resistance is defined as that is no response in spite of using in maximum dosage and enough duration at least two serotonin reuptake inhibitors or two antidepressants from different groups or clomipramine and a serotonin reuptake inhibitor. The ratio of re-sponse to first line drugs is between 40% and 60%. In resistant patients, the diagnosis, the former treatments, compliance to treatments, comorbidity must be carefully evaluated. The treatment alternatives include changing drug, augmentation with cognitive behavior therapy, the combination of two serotonin reuptake inhibitors, the using intravenous serotonin reuptake inhibitors (clomipramine, citalopram), the augmentation treatments (the other antidepressants, antipsychotics, mood stabilizers, glutamatergic agents, benzodiazepines), alternative monotherapies (MAOIs, venlafaxine, sumatriptan, glutamatergic agents, psychostimulants, buspirone, tramodol). The other treatment alternatives except for drug treatments are cognitive behavior therapy, electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation. Psychosurgery is the last alternative in resist-ant patients with nonresponsive to any treatment. The benefits of alternative treatments except for drug treatments and cognitive behavior therapy is not definite.

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