Şizofrenli hastalarda baş ağrısının değerlendirilmesi: Vaka-kontrol çalışması

Amaç: Bu çalışmada şizofrenli hastalarda sağlıklı kontrol grubu ile karşılaştırarak baş ağrısı sıklığı ve hangi tip baş ağrılarının olduğunun araştırılması amaçlandı.Yöntem: Çalışmaya 101 hasta ve 89 sağlıklı kontrol grubu alındı. Hastalara araştırmacılar tarafından hazırlanan, hastanın sosyo-demografik özelliklerinin, hastalığı ile ilgili bilgilerin ve baş ağrısı ile ilgili soruların yer aldığı sosyodemografik veri formu, DSM-IV eksen 1 tanı ölçütlerine göre hazırlanmış yapılandırılmış bir klinik görüşme formu olan SCID-1 ve Pozitif ve Negatif Belirtileri Değerlendirme Ölçeği uygulandı. Şu anda ya da geçmişte baş ağrısı olduğunu ifade eden hastalar baş ağrısının değerlendirilmesi amacıyla nöroloji polikliniğine yönlendirildi. Bulgular: Şizofrenli hasta grubunun %38.6'sı baş ağrısı tanımlarken, kontrol grubunda bu oran %37.1 olarak bulundu. Her iki grupta da en fazla gerilim tipi baş ağrısı (GTBA) görülmesine rağmen (hasta grubu=%31.7, kontrol grubu=%18) şizofreni grubunda GTBA kontrol grubundan anlamlı olarak daha fazla bulundu. Migren tipi baş ağrısı ise kontrol grubunun %11.2'sinde görülürken, hasta grubunun %2'sinde görülmekteydi. Şizofrenili hasta grubu kontrol grubuna göre baş ağrısı yakınmasını daha az dile getirmekteydi.Sonuç: Bu çalışmada şizofrenili hastaların normal popülasyon kadar baş ağrısına maruz kaldığı, baş ağrısı yakınmasını normal topluma göre daha az dile getirdikleri sonucu elde edilmiştir. Bu konuda yapılacak geniş örneklemli çalışmalar ve oluşturulacak tedavi protokolleri şizofrenili hastaların yaşam kalitesinin artmasına da katkı sağlayabilir

The Evaluation of Headache in Patients with Schizophrenia: A Case- Control Study

Objective: The aim of this study is to explore the frequency and the types of headache in patients with schizophrenia and to compare it with the healthy control group. Method: A hundred and one patients and eighty nine healthy subjects were included in this case-control study. Socio-demographic data form, structured clinical interview for DSM disorders type 1 (SCID-1), Scale for the Assessment of the Negative Symptoms (SANS) and of the Positive Symptoms (SAPS) were applied. The subjects with headache were consulted to the neurology clinic. Results: The prevalence of headache in the patient group was 38.6% whereas the prevalence of headache in the control group was 37.1%. Tension type headache (TTH) was the most prominent type in both group (31.7% of patients, 18.0% of controls) and the presence of TTH in patients with schizophrenia was found statistically significant. Migraine type headache was detected in 2.0% of patients and 11.2% of controls. The ratio of headache was lesser in patients than in the controls. Conclusion: Schizophrenic patients have headache as much as the healthy subjects but they complain less about their headache than the controls do. Further studies with larger samples in patients with schizophrenia would present the importance of the issue and improve the quality of life in patients with schizophrenia contributing the analgesia

Kaynakça

1. Green MW. Headaches: psychiatric aspects. Neurol Clin 2011; 29:65-80.

2. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd ed. Cephalalgia 2004; 24 (Suppl 1):9-160.

3. Lipton RB, Goadsby P, Silberstein SD. Classification and epidemiology of headache. Clin Cornerstone 1999; 1:1-10.

4. Siva A, Saip S. Akut Bas. Agrili Hastaya Yaklasim. In Siva A, Kaytaz A, (editors). Basagrilari, Basdonmeleri. Istanbul: Istanbul University, Cerrahpasa Faculty of Medicine, Continuous Medical Education Publications, 1998; 21-33. (Turkish)

5. Kroenke K, Price RK. Symptoms in the community: prevalence, classification, and psychiatric co morbidity. Arch Intern Med 1993; 153:2474-2480.

6. Mitsikostas DD, Thomas AM. Comorbidity of headache and depressive disorders. Cephalalgia 1999; 19:211-217.

7. Dworkin RH. Pain insensitivity in schizophrenia: a neglected phenomenon and some implications. Schizophr Bull 1994; 20:235-248.

8. Kuritzky A, Mazeh D, Levi A. Headache in schizophrenic patients: a controlled study. Cephalalgia 1999; 19:725-727.

9. Bonnot O, Anderson GM, Cohen D, Willer JC, Tordjman S. Are patients with schizophrenia insensitive to pain? A reconsideration of the question. Clin J Pain 2009; 25:244-252.

10. Raffard S, Bayard S, Capdevielle D, Garcia F, Boulenger JP, Gely-Nargeot MC. Lack of insight in schizophrenia: a review. Encephale 2008; 34:511-516.

11. Potvin S, Marchand S. Hypoalgesia in schizophrenia is in dependent of anti psychotic drugs: a systematic quantitative review of experimental studies. Pain 2008; 138:70-78.

12. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Washington DC: American Psychiatric Press; 1996.

13. Corapcioglu A, Aydemir O, Yildiz M, Esen A, Koroglu E. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinical Version. Ankara: Hekimler Yayin Birligi, 1999. (Turkish)

14. Andreasen NC. Scale for the Assessment of Negative Symptoms (SANS). Iowa City: IA University of Iowa, 1983.

15. Erkoc S, Arkonac O, Ataklİ C, Ozmen E. Reliability and validity of negative symptoms rating scale. Düşünen Adam Journal of Psychiatry and Neurological Sciences. 1991; 4:16-19. (Turkish)

16. Andreasen NC: Scale for the Assessment of Positive Symptoms (SAPS). Iowa City, IA, University of Iowa, 1984.

17. Erkoc S, Arkonas O, Atakli C, Ozmen E. Validity and reliability of Scale for the Assessment of Positive Symptoms. Düşünen Adam Journal of Psychiatry and Neurological Sciences. 1991; 4:20-24. (Turkish)

18. Grebb JA, Cancro R. Schizophrenia: Clinical Features. Kaplan HI, Sadock BJ, (editors). In Comprehensive Textbook of Psychiatry. Baltimore: Williams and Wilkins; 1989.

19. Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry 1988; 145:1358-1368.

20. Oner R, Tugcu H, Ozsan HH. Somatization in patients with schizophrenia. Turkiye Klinikleri Journal of 2002; 3:1-5. (Turkish)

21. Breslau N, Davis GC, Andreski P. Migraine, psychiatric disorders, and suicide attempts: an epidemiologic study of young adults. Psychiatry Res 1991; 37:11-23.

22. Edmeads J, Findlay H, Tugwell P, Pryse-Phillips W, Nelson RF, Murray TJ. Impact of migraine and tension-type headache on life style, consulting behavior, and medication use: a Canadian population survey. Can J Neurol Sci 1993; 20:131-137.

23. Rasmussen BK. Epidemiology of headache. Cephalagia 1995; 15:45-68.

24. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population-a prevalence study. J Clin Epidemiol 1991; 44:1147-1157.

25. Steward WF, Schetcher A, Rasmussen BK. Migraine prevalence. A review of population-based studies. Neurology 1994; 44:17- 23.

26. Boru UT, Kocer A, Luleci A, Sur H, Tutkan H, Atli H. Prevalence and characteristics of migraine in women of reproductive age in Istanbul, Turkey: a population based survey. Tohoku J Exp Med 2005; 206:51-59.

27. Wang SJ, Fuh JL, Lu SR, Juang KD. Chronic daily headache in adolescents: prevalence, impact, and medication overuse. Neurology 2006; 66:193-197.

28. Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton RB, Scher AI, Steiner TJ, Zwart JA. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27:193-210.

29. Key FN, Donmez S, Tuzun U. Epidemiological and clinical characteristics with psychosocial aspects of tension-type headache in Turkish college students. Cephalalgia 2004; 24:669- 674.

30. Kocer E, Degirmenci Y, Kocer A, Ataoglu A. The frequency of headache in Turkish patients with psychiatric disorders. New Symposium 2010; 48:132-138.

31. Saip S. Primer basagrilari. In Siva A, Saip S, Kaynak D, (editors). Norolog Olmayanlar Icin Noroloji. Istanbul: Istanbul University Cerrahpasa Faculty of Medicine, Continuous Medical Education Publications 2005; 35-62. (Turkish)

32. Kocher R. Psychopharmaceuticals in chronic pain. Schweiz Med Wochenschr 1981; 111:1946-1954.

33. Jakubaschk J, Boker W. Disorders of pain perception in schizophrenia. Arch Neurol Psychiatr 1991; 142:55-76.

34. Guieu R, Samuelian JC, Coulouvrat H. Objective evaluation of pain perception in patients with schizophrenia. Br J Psychiatry 1994; 164:253-255.

35. Jochum T, Letzsch A, Greiner W, Wagner G, Sauer H, Bär KJ. Influence of antipsychotic medication on pain perception in schizophrenia. Psychiatry Res 2006; 142:151-156.

Kaynak Göster

  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984

6.2b 3.7b