İsmail AKALTUN, Soner Sertan KARA, Hamza AYAYDIN, Tayfun KARA

Nörolojik tutulumu olmayan brusellozlu çocuk ve ergenlerin depresyon açısından değerlendirilmesi

Amaç: Brusella enfeksiyonu, subklinik enfeksiyondan, ağır bakteriyemi veya santral sinir sistemi enfeksiyonlarına kadar değişken kliniklerle karşımıza çıkabilmektedir. Amaç nörobrusellozlu olmayan brusellozlu olguların, brusellozlu olmayan kontrol grubu ile depresyon oranlarını karşılaştırmaktır.Gereç ve Yöntem: 60 brusellozlu ve 60 kontrol grubu olmak üzere toplamda 120 çocuk ve ergen çalışmaya dahil edildi. Tüm katılımcılara The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children -Present and Lifetime Version-Turkish Version (K-SADS-PL-T) uygulanmış olup, DSM-5 tanı ölçütlerinin göz önünde bulundurulduğu psikiyatrik değerlendirme yapılmıştır. Katılımcılara ayrıca bilgi formu verilmiş olum tüm katılımcılara The Children's Depression Inventory (CDI) ölçeği verilerek değerlenirildi.Bulgular:Brusellozlu hastaların 16’sında (%26,7), kontrol grubunun ise 3’ünde (%5) K-SADS-PL-T’ye göre depresyon tanısı, vaka grubunda kontrol grubuna göre istatistiksel olarak yüksek bulunmuştur(p=0.002). CDI puanları açısından karşılaştırıldığında, vaka grubunda kontrol grubuna göre istatistiksel olarak yüksek bulunmuştur (p< 0.001).bulunmuştur (p< 0.001).Sonuç: Norolojik tutulum olmasa da brusellozlu çocuk ve ergenlerde depresyonun sağlıklı kontrollere göre yüksek oranda görülmesi, bu olguların ruhsal açıdan değerlendirilmesinin önemini düşündürtmektedir.

Anahtar Kelimeler:

bruselloz, depresyon, çocuk ve ergen

Evaluation of depression among children and adolescents with brucellosis without neurological involvement

Purpose: Brucella infection may appear with varying clinical manifestations, from subclinical infection to severe bacteremia or central nervous system infections. The aim of this study was to compare depression rates in brucellosis cases without neurobrucellosis with a non-brucellosis control group.Materials and Methods: One hundred and twenty children and adolescents, 60 with brucellosis and 60 controls, were included in the study. All subjects were administered the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children -Present and Lifetime Version-Turkish Version (K-SADS-PL-T), and psychiatric evaluation was performed on the basis of DSM-5 diagnostic criteria. Subjects were also assessed with the administration of the Children's Depression Inventory (CDI) and a detailed information form.Results:Depression was diagnosed in 16 (26.7%) of the patients with brucellosis, and in 3 (5%) of the control group, the incidence being significantly higher in the case group (p=0.002). CDI scores were also higher in the case group than in the control group (p< 0.001).Conclusion:The higher rate of depression in children and adolescents with brucellosis, even in the absence of neurological involvement, suggests the importance of these cases being evaluated in psychological terms.

Keywords:

Brusellosis, depression, child and adolescent,

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1. Sung E, Son M. Depression in children and adolescents. American Family Physician. 2000;62:2297-308.
2. Ward RK, Eyler AE, Makris GR. Evaluatıon and management of depressive illness in adolescence. Clinics in Family Practice. 2000;4: 251-60.
3. Tanrıöver S. Depresyon. III. Anadolu Psikiyatri Günleri. In: Bekaroğlu M, ed. Çocukluk çağı depresyonunda tarihsel geçmiş. Trabzon: Karadeniz Ruh Sağlığı Derneği 1995;2:306-31432. in Turkish
4. Harrington R. Depressive disorder in adolescence.Arch Dis Child. 1995;72:193-5.
5. Duman RS, Malberg J, Nakagawa S: Neuronal Plasticity and survival in mood disorders. Biol Psychiatry. 2000;48:732-9.
6. Penninx BW, Milaneschi Y, Lamers F, Vogelzangs N. Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile. BMC Med. 2013;11:129.
7. Voinov B, Richie WD, Bailey RK. Depression and chronic diseases: it is time for a synergistic mental health and primary care approach. Prim Care Companion CNS Disord. 2014;15(2).
8. Adams TB, Wharton CM, Quilter L, Hirsch T. The association between mental health and acute infectious illness among a national sample of 18- to 24-year-old college students. J Am Coll Health. 2008;56:657–63.
9. Uzuner A, Akman M . Depresyonun Nörobiyolojisi. Turkiye Klinikleri J Fam Med-Special Topics. 2017;8:7-14. in Turkish.
10. Capuron L, Dantzer R. Cytokines and depression: the need for a new paradigm. Brain Behav Immun. 2003;17:119-24.
11. Kaur N, Kumar P, Malhotra S, Madan P, Bhatia MS. Infections, Depression and Suicidal Behaviour. Delhi Psychiatry Journal. 2015;18:1.
12. Tanıdır Y, Gümrah A, Akbal C, Tarcan T. Brucella epididymo-orchitis as the first presenting sign of brucellosis: A case report and review of the literature. Marmara Medical Journal. 2008;21:56-60.
13. Young EJ. An overview of human brucellosis. Clin Infect Dis. 1995;21:283–9.
14. Doganay M, Bilgehan A. Human brucellosis: An overview. Int J Inf. Dis. 2003;7:173-81.
15. Buzgan T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O et al. Clinical manifestations and complications in 1028 cases of brucellosis: A retrospective evaluation and review of the literature. Int J Infect Dis. 2010;14:469-78.
16. Logan LK, Jacobs NM, McAuley JB, Weinstein RA, Anderson EJ. A multicenter retrospective study of childhood brucellosis in Chicago, Illinois from 1986 to 2008. Int J Infect Dis. 2011;15:812-7.
17. Tanir G, Tufekci SB, Tuygun N. Presentation, complications, and treatment outcome of brucellosis in Turkish children. Pediatr Int. 2009;51:114-9.
18. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC. 2013.
19. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36:980-8.
20. Gökler B, Ünal F, Pehlivantürk B, Çengel-Kültür E, Akdemir D, Taner Y. Reliability and validity of schedule for affective disorders and schizophrenia for school age children-present and lifetime versionTurkish.
21. Kovacs M. The Children’s depression inventory (CDI). Psychopharmocol Bull. 1985;21:995-8. 22. Öy B. Children’s Depression Inventory: a study of reliability and validity. Turk Psikiyatri Derg. 1991;2:132-6.
23. Zhao S, Cheng Y, Liao Y, Zhang Z, Yin X, Shi S. Treatment efficacy and risk factors of neurobrucellosis. Med Sci Mon. 2016;221005-12.
24. Gul HC, Erdem H, Bek S. Overview of neurobrucellosis: a pooled analysis of 187 cases. Int J Infect Dis. 2009;13:339-43.
25. Demiroğlu YZ, Turunç T, Karaca S, Arlier Z, Aliskan H, Colakoglu S et al. Bruselloza sinir sistemi tutulumu; klinik sınıflama, tedavi ve sonuçlar. Mikrobiyol Bul. 2011;45:401-10.
26. Abdolbagi MH, Rasooli-Nejad M, Jafari S, Hasibi M, Soudbakhsh A. Clinical and laboratory findings in neurobrucellosis: review of 31 cases. Arch Iran Med. 2008;11:21-5.
27. Shehata GA, Abdel-Baky L, Rashed H, Elamin H. Neuropsychiatric evaluation of patients with brucellosis. J Neurovir. 2010;16:48-55.
28. Yetkin MA, Bulut C, Erdinç FS, Oral B, Tulek N. Evaluation of the clinical presentations in neurobrucellosis. Int J Infect Dis. 2006;10:446-52.
29. Yüce A, Alp-Çavuş S. Türkiye’de bruselloz: genel bakış. Klimik Derg. 2006;3:87-97. in Turkish.
30. Dağlar DE, Baysan BÖ. İnsanda brusella enfeksiyonlarının tanısında kullanılan tanı yöntemleri. İnönü Üniv Sağlık Bil Derg. 2014;3:46-8. in Turkish.
31. Eren S, Bayam G, Ergönül O, Celikbaş A, Pazvantoğlu O, Baykam N et al. Cognitive and emotional changes in neurobrucellosis. J Infect. 2006;53:184-9.
32. Eini P, Majzoobi MM, Ahmadpanah M, Mamani M. Depressive disorder among brucellosis patients in Hamadan, Iran: A case-control study. Life Science Journal. 2012;9:2534-7.
33. Ahmed K, Al-Matrouk KA, Martinez G, Oishi K, Rotimi VO, Nagatake T. Increased serum levels of interferon-gamma and interleukin-12 during human brucellosis. Am J Trop Med Hyg. 1999;61:425-7.
34. DieZ-Ruiz A, al-Amrani M, Weis G, Gutierrez-Gea F, Wachter H, Fuchs D. Increased interferon-gamma and neopterin concentrations in patients with acute brucellosis.J Infect Dis. 1993;167:504-5.
35. Budak F, Göral G, Heper Y, et al. IL-10 and IL gene polymorphisms as potential host susceptibility factors in brucellosis. Cytokine 2007;38:32-6.
36. Karsen H, Irmak H, Karahocagil MK, Cesur S, Fidan Y, Öğüş E. Brusellozlu Hastalarda Serum Sitokin Düzeylerinin (Neopterin, interlökin-6, interlökin-12, ve interferon-gama) Tanısal Değeri. Van Tıp Dergisi. 2011;18:92-95.
37. Refik M, Mehmet N, Durmaz R, et al Cytokine profile and nitric oxide levels in sera from patients with brucellosis. Braz J Med Biol Res. 2004;37:1659-63.
38. Dantzer R, O’Connor J, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008;9:46-56.
39. Schiepers OJ, Wichers MC, Maes M. Cytokines and major depression. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29:201-17.
40. Maes M, Ringel K, Kubera M, Berk M, Rybakowski J. Increased autoimmune activity against 5-HT: a key component of depression that is associated with inflammation and activation of cell-mediated immunity, and with severity and staging of depression. J Affect Disord. 2012;136:386-92.
41. DuHamel KN, William HR, Vickberg MJ. Behavioral interventions in the diagnosis, treatment and rehabilitation of children with cancer. Acta Oncol. 1999;38:719-34.
42. Ekşi A, Molzan J, Savaşır I, Güler N. Psychological adjustment of children with mild and moderately severe asthma. Eur Child Adolesc Psychiatry. 1995;4:77-84.
43. Orr DP, Weller SC, Satterwhite B, Pless IB. Psychosocial implications of chronic illness in adolescence. J Pediatr. 1984;104:152-7.
44. Gökler B. Ölümcül hastalık karşısında çocuk, aile ve hekim. Katkı Pediatri Dergisi. 1996; 17:921-924. in Turkish
45. Deniz Ü, Aral N. Kronik hastalığı olan ve olmayan çocukların davranış problemlerinin yaş ve cinsiyete göre incelenmesi. Çağdaş Eğitim Dergisi 2003;28:37- 44. in Turkish
46. Er MD, Mağden D. Hastaneye ilk kez yatan üçdokuz yaş arasındaki çocuklarda görülen davranış değişiklikleri. Sağlık Dergisi 1994; 66: 11-18. in Turkish.
47. Miman O, Mutlu EA, Ozcan O, Atambay M, Karlidag R, Unal S. Is there any role of Toxoplasma gondii in the etiology of obsessive-compulsive disorder?. Psychiatry Res. 2010;177:263-5.
48. Shugart MA. psychiatry consultations to pediatric inpatients: A literature review. Gen Hosp Psychiatry. 1991;13:325-36.
49. Denys D, Fluitman S, Kavelaars A, Heijnen C, Westenberg H. Decreased TNF-alpha and NK activity in obsessive-compulsive disorder. Psychoneuroendocrinology. 2004;29:945-52.
50. Irwin M. Psychonueroimmunology of depression: clinical Implications. Brain Behav Immun. 2002;16:1- 16.
51. Zorilla EP, Luborsky L, McKay JR et al. The relationship of depression and stressors to immunological assays: a metaanalytic review. Brain Behav Immun. 2001;15:199-226.
52. Miller GE, Cohen S, Herbert TB. Pathways linking major depression and immunity in ambulatory female patients. Psychosom Med. 1999;61:850-60.