Kürşat ALTINBAŞ, Sinan GÜLÖKSÜZ, Sera YİĞİTER, Erhan KURT, E. Timuçin ORAL

Uzmanlaşmış bir merkezde izlem iki uçlu depresyon belirti sayısını ve şiddetini etkiler mi?

Amaç: İki uçlu bozukluk hastaları, hayatlarının önemli bir bölümünde depresif belirtiler yaşamaktadırlar. Buna karşın, iki uçlu depresyon belirti örüntüsü oldukça az çalışılmıştır. İki uçlu depresif dönemde, hastaların daha çok atipik depresyon belirtileri yaşaması beklenirken, etnokültürel farklılıklar ve düzenli izlem, klinik belirtilerin ortaya çıkış şeklini ve dışavurumunu etkileyebilmektedir. Buradan hareketle, bu çalışmada özelleşmiş bir duygudurum merkezinde takip edilen iki uçlu hastaların depresif dönemde yaşadıkları belirtilerin gözden geçirilmesi amaçlanmıştır. Yöntem: Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Hastanesi Raşit Tahsin Duygudurum Merkezi’nde iki uçlu bozukluk tanısıyla takip edilmekte olan 144 hastanın en şiddetli depresif dönemine ilişkin belirtileri kaydedilmiştir. Klinik belirtiler yapılandırılmış bir veri formundan ve hastane kayıtlarından elde edilmiştir. Depresif belirtiler, tanımlayıcı istatistikle değerlendirilmiştir. Bulgular: Hastaların %10’undan daha azında depresif belirtilerin şiddetli olduğu saptandı. Suçluluk duygusu ve benlik saygısında azalma hastaların yaklaşık yarısında görülmezken (%45,8), aktif (%3,5) ya da pasif (%15,3) intihar fikri yaklaşık beşte bir oranında görülmekteydi. Psikotik belirtilerin görülme oranı ise oldukça düşüktü (%4,2). Ayrıca enerji kaybı ve dikkat-konsantrasyon güçlüğü dışındaki vejetatif bulgular hastaların yarısından daha çoğunda görülmemekteydi. Tedavide ise, duygudurum dengeleyici ekleme ya da doz titrasyonu ve terapötik görüşmenin hastaların yaklaşık üçte birinde remisyon için yeterli olduğu saptandı. Tartışma ve Sonuç: İki uçlu depresyonun, daha şiddetli seyrettiği ve daha sık özkıyım girişimiyle ilişkili olduğu bildirilmesine karşın, tüm belirtiler için, şiddetli olan vakaların oranının %10’un altında ve aktif özkıyım fikrine sahip vakaların oranının %3,5 olduğu tesbit edilmiştir. Ayrıca, psikotik bulguların sıklığı %4,2 olarak bulunmuştur. Daha hafif şiddette belirtilerin görülmesi literatürle çelişse de, bu durum hastaların uzmanlaşmış bir birimde takip edilmesi ve belirtilerin şiddetlenmeden müdahale edilmesi ile açıklanabilmektedir. Hastalara daha az farmakolojik tedavi müdahalesinde bulunma ihtiyacı da, aynı nedenden kaynaklanabilmektedir.

Does follow-up in a specialized center influence symptom profile and severity of bipolar depression?

Introduction: Despite bipolar patients spend up to one third of their lives in depression, the treatment of bipolar depression remains as an understudied area. Although more atypical depressive symptoms are expected to be seen in bipolar depression, ethnocultural differences and regular follow-ups can change the onset and expression of clinical symptoms. Thus, in the present study, we aimed to evaluate the symptoms of depressive bipolar patients who are followed up in a specialized mood disorder unit. Methods: The most severe depressive symptoms of 144 bipolar patients were followed up using standardized forms in a specialized mood disorder outpatient unit. Obtained data analyzed by descriptive statistics. Results: It was determined that less than 10% of depressive symptoms were severe. Feelings of guilt and low self-esteem were not detected in nearly half of the patients (45,8%); active (3,5%) or passive (15,3%) suicidal ideation was seen approximately in one-fifth of the patients. The rate of psychotic symptoms was considerably low (4,2%). Beside this, vegetative symptoms other than loss of energy and lack of concentration were not seen in more than half of the patients. Adding a mood stabilizer or titrating the levels and psychotherapeutic interventions were adequate for remission in one-third of the patients. Discussion: Although previously it was reported bipolar depressive symptoms were severe with higher suicide rates, in less than 10% of patients, depressive symptoms were severe and the rate of active suicidal ideation was 3,5% in our study. Moreover, the rate of psychotic symptoms was found 4,2%. Although occurrence of milder symptoms contradicts with the literature, this can be explained by the follow-up of the patients in a specialized unit and early intervention before symptoms get more severe. Decreased need for pharmacological intervention can also be explained by the same reason.

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