Mustafa BİLİCİ, Sermin KESEBİR, EVRİM ÖZKORUMAK KARAGÜZEL, ÖMER YANARTAŞ, Sema İŞİTMEZ

Türkiye'de bipolar bozukluğun ele alınmasında pratik uygulamalar ve hasta özelliklerinin kesitsel incelenmesi

Amaç: Bipolar bozukluk (BB), tıbbi ve ruhsal bozukluklar arasında önemli yeti yimine yol açan yaygın, kronik bir bozukluktur. Bu çalışma Türkiye"de ayaktan izlenen hastaların klinik özellikleri ve pratik örüntülerini belirlemek amacıyla planlanmıştır. Yöntem: Çok merkezli kesitsel olan bu çalışmaya 12 ay içinde ayaktan psikiyatri hizmetleri veren 31 kliniğe başvuran DSM-IV ölçetlerine göre tanı konan 1001 hasta alınmıştır. Hastaların demografik, klinik özellik, aile öyküsü, eşlik eden ruhsal bozukluklar ve tedavi modaliteleri yarı yapılandırılmış bir anketle değerlendirilmiştir. Bulgular: Hastalığın başlangıç yaşı 26.7±9.8, tanı konan yaş 28.9±10.4 ve ikisinin arasındaki süre 2.2±4.7 yıldır. Şu anki tanıdan önce yanlış tanı konma oranı %40.3"dür. En sık ilk nöbet tipi mani (%57.1) ve depresyondur (%34.5). Eşlik eden ruhsal hastalık hastaların %12"sinde saptanmıştır. Hastaların yalnız %10"u monoterapi almaktadır. En sık reçete edilen ilaçlar depresif, manik ve karma nöbetler için sırasıyla lityum, sodyum valproat ve ketiyapindir. Sonuç: Türkiye"deki örneklemde belirtilerin başlangıcı ve ilk tanı alma arasındaki süre daha once yapılan çalışmalarda bildirilen sürelerden kısadır. Yanlış tanı alma oranları daha önce yapılan çalışmalarla benzerdir. Eşlik eden ruhsal hastalık oranının düşük çıkması Türk toplumu örnekleminde eşlik eden ruhsal bozukluk yaygınlığının düşük olması ile ilişkilidir. Lityum, sodyum valproat ve atipik antipsikotikler Türkiye"de en sık kullanılan ilaç tedavilerdir.

A cross-sectional analysis of patient characteristics and practice patterns in the management of bipolar disorder across Turkey

Objective: Bipolar disorder (BD) is one of the leading causes of disability among medical and psychiatric disorders associated with prevalent, chronic, severe and highly disabling characteristics. This study was designed to identify clinical characteristics and practice patterns in the management of outpatients with BD across Turkey. Method: This multi-center cross-sectional study involving 1001 patients diagnosed with using DSM-IV criteria was conducted prospectively at 31 outpatient psychiatry clinics for 12 months. Patient demographics, clinical features, family history, comorbid psychiatric disorders, and the treatment modalities were assessed by means of semistructured questionnaire. Results: Age at the onset of symptoms was 26.7±9.8 years, age at diagnosis was 28.9±10.4 years, and the time interval between them was 2.2±4.7 years. Misdiagnosis prior to current diagnosis was evident in 40.3% of bipolar patients. The most common type of first episode was mania (57.1%) and depression (34.5%). Comorbid psychiatric illness was identified in 12.0% of patients. Only 10% of patients were receiving monotherapy. The most commonly prescribed drugs for depressive, manic and mixed episodes were lithium, sodium valproate and quetiapine, respectively. Conclusion: The time interval between onset of symptoms and the initial diagnosis in Turkish sample was quite shorter than reported in the literature. The misdiagnosis rate in the present study and recent studies were similar. A low comorbidity rate appears to indicate a lower prevalence of comorbid disorders in BD in Turkish sample. Lithium, sodium valproate and atypical antipsychotics were more commonly used drugs in the treatment of BD in Turkey.

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