Tuğba ESEROĞLU, ÖZHAN YALÇIN, ALİ GÜVEN KILIÇOĞLU, GÜL KARAÇETİN

İlk atak psikoz tanısıyla yatarak tedavi gören ergen hastalarda madde kullanım bozukluğu eş tanısının tedavi yanıtı üzerine etkisi

Amaç: Psikotik bozukluklarda madde kullanım bozukluğu (MKB) eş tanısı sıktır. Bu çalışmada MKB eş tanısı olan ilk atak psikoz (İAP) tanısıyla yatarak tedavi gören ergenlerde tedavi seçiminde, süresinde ve tedaviden görülen faydada farklılık olup olmadığının araştırılması amaçlanmıştır. Yöntem: Çalışmamıza İAP tanısı konmuş ve yatarak tedavi gören 14-18 yaşları arasındaki 56 ergen alınmıştır. Tüm ergenler ve aileleri ile görüşülerek Sosyodemografik Veri Formu doldurulmuştur. Servise yatışta ve taburculuk öncesinde Pozitif ve Negatif Sendrom Ölçeği (PNSÖ), Kısa Psikiyatrik Değerlendirme Ölçeği (KPDÖ), Klinik Global İzlenim Ölçeği (KGİ) ve gerek görülen ergenlerde Young Mani Derecelendirme Ölçeği doldurulmuştur. Görüşme sonrasında hastalar yaşamının bir döneminde ve/veya şu anda MKB eş tanısı konanlar (26 kişi) ve konmayanlar (30 kişi) olarak iki gruba ayrılmıştır. Sonuçlar: MKB eş tanısı olan grupta en sık tercih edilen maddeler sentetik kannabinoidler (%46.2) ve esrar (%23.1) olarak saptanmıştır. İAP grubunda olanzapin, biperiden ve benzodiyazepinler; MKB eş tanısı olan grupta ise risperidon daha sık tercih edilmiş, diğer antipsikotiklerin, duygudurum düzenleyicilerin ve bornaprinin kullanımında iki grup arasında anlamlı fark bulunmamıştır. Serviste yatış süreleri benzer bulunmuştur. Giriş ve çıkış ölçek puanları karşılaştırıldığında, MKB eş tanılı grupta çıkış PNSÖ pozitif alt ölçek puanlarında daha yüksek puanlar saptanmıştır. Giriş ve çıkış ölçek puanları arasındaki düzelme oranlarında iki grup arasında fark yoktur. Tartışma: Psikoaktif maddelerin psikotik bozukluklardaki sıklığıyla ilgili çalışmalar sıktır, ancak tedavi sürecine etkisiyle ilgili olarak özellikle ergen yaş döneminde verilerimiz sınırlıdır. Bizim çalışmamızda MKB eş tanısı varlığında tedavi süresi ve tedaviden görülen faydada bir farklılık bulunmamakla birlikte, konuyla ilgili daha geniş örneklemli ve izleme çalış- malarına gerek vardır. (Anadolu Psikiyatri Derg 2019; 20(4):385-394)

The influence of substance use disorder comorbidity on the treatment response of inpatient adolescents with the diagnosis of first episode psychosis

Objective: The comorbidity of substance use disorders (SUD) in psychotic disorders are common. In this study, it was aimed to investigate whether there was any difference in treatment choice, duration and treatment benefit in adolescents with first episode psychosis (FEP) diagnosis in the presence of SUD comorbidity. Methods: The study included 56 people aged between 14-18 years who were diagnosed with IAP and hospitalized. The sociodemog- raphic data form was completed by interviewing all the patients and their families. Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale (CGI) and Young Mania Rating Scale were used. After the interview, patients were divided into two groups, one at the lifetime and/or cur- rently being diagnosed with SUD (26 patients) and not (30 patients). Results: In the SUD comorbid group the most frequent used substances were determined as synthetic cannabinoids (46.2%) and cannabis (23.1%). Olanzapine, biperiden and benzodiazepines were more common used in the IAP group, and risperidone was more preferred in the comorbid group. The duration of hospitalization were similar. When the scale scores in the entry and discharge were compared, higher scores were found in the PANNS positive subscale scores in the comorbid group. There was no difference between the two groups when the improvement rates between the entry and discharge scale scores were compared. Conclusion: Studies on the frequency of psychoactive substances use in psychotic disor- ders are common, but our data on the effect of its on the treatment process are quite limited, especially during adolescent age. In our study, in the presence of SUD comorbidity although there are no differences in the duration of treatment and benefit from the treatment, larger samples and follow-up studies are needed. (Anatolian Journal of Psychiatry 2019; 20(4):385-394)

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