Faruk PİRİNÇÇİOĞLU, Sıdıka BAZİKİ ÇETİN, Mehmet ASOĞLU

Bipolar Bozukluk Tanılı Hastaların Yakınlarının Duygu Dışa Vurumlarının Zihin Kuramı Becerileri ile İlişkisi

Amaç: Bipolar bozukluğun gidişatını belirlediği düşünülen aile faktörlerinin çoğunluğu duygu dışa vurumu kavramı içinde incelenmektedir. Zihin kuramı kavramı, diğer kişilerin duygularını, niyetlerini, anlayıp tahmin etme ve zihinsel olarak bunları temsil edebilme becerisidir. Bu araştırmada bipolar bozukluk tanılı hasta yakınlarının duygu dışa vurumlarının ve zihin kuramı işlevlerinin saptanması ve bunların hastaların işlevselliği ile olan ilişkisinin incelenmesi amaçlanmaktadır. Materyal ve metod: Araştırmaya DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) tanı kriterlerine göre bipolar bozukluk tanısı konulan 95 hasta ve aynı sayıda hasta yakını dahil edildi. Bipolar bozukluk tanılı Hastalarla hasta yakınlarını değerlendirmek için sosyodemografik ve klinik veri formu uygulandı. Hasta yakınlarına, zihin kuramı becerilerini değerlendirmek için gözlerden zihin okuma testi ve duygu dışa vurum ölçeği kullanıldı. Hastaların işlevselliğini değerlendirmek için ise kısa işlevsellik değerlendirme ölçeği uygulandı. Bulgular: Çalışmada hasta yakınlarının gözlerden zihin okuma test puanları ile duygu dışa vurum ölçek puanları arasında negatif yönde anlamlı bir korelasyon tespit edilmiştir. Hasta yakınlarının gözlerden zihin okuma test puanları ile hastaların kısa işlevsellik değerlendirme ölçeği puanları arsında negatif yönde anlamlı bir korelasyon tespit edilmiştir. Hasta yakınlarının duygu dışa vurum ölçek puanları ile hastaların kısa işlevsellik değerlendirme ölçeği puanları arasında pozitif yönde anlamlı bir korelasyon tespit edilmiştir. Sonuç: Çalışma sonucunda hasta yakınlarının gözlerden zihin okuma testi ile belirlenen zihin kuramı becerileri ne kadar iyiyse hastaya olan duygu dışa vurumlarının anlamlı derecede düşük olduğu, hasta yakınlarının gözlerden zihin okuma testi ile belirlenen zihin kuramı becerileri ne kadar kötü ise hastaya olan duygu dışa vurumlarının anlamlı derecede yüksek olduğu belirlenmiştir

Anahtar Kelimeler:

bipolar bozukluk, duygu dışavurumu, zihin kuramı

Relation of Emotion Expression of Relatives of Patients with Bipolar Disorder with Mental Theory Skills

Background: Most of the family factors that are thought to determine the course of the disease are examined with in the concept of Emotion Expression. The concept of theory of mind is the ability to understand and predict other people's emotions, intentions and mentally represent them. In this study, it is aimed to determine the emo-tion expressions and mind theory functions of first degree relatives of bipolar disorders patient relatives and to investigate their relations with each other. Materials and Methods: The study included 95 patients diagnosed with bipolar disorder according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria and the same number of relatives. Soci-odemographic and clinical data form was used to evaluate patients with bipolar disorder and their relatives. To assess the theory of mind skills of the patients' relatives, mind reading test and emotional expression scale were used. Short Functioning Assessment Scale was used to evaluate the functionality of the patients. Results: The study included 95 patients diagnosed with bipolar disorder type-1 according to DSM-5 diagnostic criteria. 55 (57.9%) of the participants were female and 40 (42.1%) were male. 30 (31.6%) were single, 63 (66.3%) were married and 2 (2.1%) were divorced. A negative correlation was found between the mental reading test scores of the patient's relatives and the emotional expression scale scores (r: -0,621, p<0,001). A negative corre-lation was found between the eyes test scores of the relatives of the patients and the short functionality assess-ment scale scores of the patients (r:-0,618, p:<0,001). A significant positive correlation was determined between the emotional expression scale scores of the relatives of the patients and the the short functionality assessment scale scores of the patients (r: 0,630, p:<0,001). Conclusions: As a result of the study, it was determined that the beter the theory of mind skills of the relatives of the patients, the lower the emotional expressions to the patient, the worse the patient's relatives theory of mind skills determined by eyes test, the higher the emotional expression to the patient. Key Words: Bipolar disorder, Emotion expression, Mind theory

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1. Brüne M, Brüne-Cohrs U. Theory of mind—evolution, ontog-eny, brain mechanisms and psychopathology. Neuroscience & Biobehavioral Reviews. 2006; 30(4):437-55.
2. Stone V.E, Baron-Cohen S, Knight RT. Frontal lobe contribu-tions to theory of mind. Journal of cognitive neuroscience. 1998;10(5):640-56.
3. Couture SM, Penn DL, Roberts DL. The functional significance of social cognition in schizophrenia: a review. Schizophrenia bulletin. 2006;32(suppl_1):S44-63.
4. Baron-Cohen S, Leslie AM, Frith U. Does the autistic child have a “theory of mind”?. Cognition. 1985;21(1):37-46.
5. Baron-Cohen S. Theory of mind and autism: A review. Interna-tional review of research in mental retardation. 2000;23:169-84.
6. Yildirim EA, Kaşar M, Güdük M, Ateş E, Küçükparlak İ, Özalme-te EO. Gözlerden zihin okuma testi’nin Türkçe güvenirlik çalış-ması. Turk Psikiyatri Dergisi. 2011;22(3):177-86.
7. Flavell JH. Cognitive development: Children's knowledge about the mind. Annual review of psychology. 1999;50(1):21-45.
8. Baron‐Cohen S, Jolliffe T, Mortimore C, Robertson M. Another advanced test of theory of mind: Evidence from very high functioning adults with autism or Asperger syndrome. Journal of Child psychology and Psychiatry. 1997;38(7):813-22.
9. Brüne M. “Theory of mind” in schizophrenia: a review of the literature. Schizophrenia bulletin. 2005;31(1):21-42.
10. Doody GA, Götz M, Johnstone EC, Frith CD, Owens DC. Theory of mind and psychoses. Psychological medicine. 1998;28(2):397-405.
11. Dunner DL, Fleiss JL, Fieve RR. The course of development of mania in patients with recurrent depression. The American journal of psychiatry. 1976.
12. Yazıcı O. Unipolar mania: a distinct entity?. Journal of affective disorders. 2014;152:52-6.
13. Bora E, Özerdem A. Social cognition in first-degree relatives of patients with bipolar disorder: A meta-analysis. European Neuropsychopharmacology. 2017;27(4):293-300.
14. Unal S, Kaya B, Cekem B, Ozişik HI, Cakil G, Kaya M. Family functioning in patients with schizophrenia, bipolar affective disorder and epilepsy. Turkish Journal of Psychiatry. 2004;15(4):291-9.
15. Fristad MA, Young AS, Vesco AT, Nader ES, Healy KZ, Gardner W, et al. A randomized controlled trial of individual family psy-choeducational psychotherapy and omega-3 fatty acids in youth with subsyndromal bipolar disorder. Journal of Child and Adolescent Psychopharmacology. 2015;25(10):764-74.
16. Butzlaff RL, Hooley JM. Expressed emotion and psychiatric relapse: a meta-analysis. Archives of general psychiatry. 1998;55(6):547-52.
17. Hooley JM, Gotlib IH. A diathesis-stress conceptualization of expressed emotion and clinical outcome. Applied and Preven-tive Psychology. 2000;9(3):135-51.
18. Fernandes FD, Gigante AD, Berutti M, Amaral JA, de Almeida KM, de Almeida Rocca CC et al. Facial emotion recognition in euthymic patients with bipolar disorder and their unaffected first-degree relatives. Comprehensive psychiatry. 2016;68:18-23..
19. Bauer M, Unützer J, Pincus HA, Lawson WB. Bipolar disorder. Mental health services research. 2002;4:225-9.
20. Miklowitz DJ, George EL, Axelson DA, Kim EY, Birmaher B, Schneck C et al. Family-focused treatment for adolescents with bipolar disorder. Journal of affective disorders. 2004;82:S113-28..
21. Hooley JM. Expressed emotion and relapse of psychopatholo-gy. Annu. Rev. Clin. Psychol. 2007;3:329-52.
22. McFarlane WR, Lukens E, Link B, Dushay R, Deakins SA, New-mark M, et al. Multiple-family groups and psychoeducation in the treatment of schizophrenia. Archives of General Psychia-try. 1995;52(8):679-87.
23. Huxley NA, Parikh SV, Baldessarini RJ. Effectiveness of psycho-social treatments in bipolar disorder: state of the evidence. Harvard review of psychiatry. 2000;8(3):126-40.
24. Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipo-lar disorder. Archives of general psychiatry. 2003;60(9):904-12..
25. Miklowitz DJ, Otto MW, Frank E, Reilly-Harrington NA, Wisniewski SR, Kogan JN et al. Psychosocial treatments for bi-polar depression: a 1-year randomized trial from the System-atic Treatment Enhancement Program. Archives of general psychiatry. 2007;64(4):419-26.
26. Cakir S, Özerdem A. Psychotherapeutic and psychosocial ap-proaches in bipolar disorder: a systematic literature review. Turk Psikiyatri Dergisi. 2010;21(2):1.
27. Brüne M. Social cognition and psychopathology in an evolu-tionary perspective. Psychopathology. 2001;34(2):85-94.
28. Saxe R, Carey S, Kanwisher N. Understanding other minds: linking developmental psychology and functional neuroimag-ing. Annu. Rev. Psychol. 2004;55:87-124.