Esrar Kullanymyna Ba?ly Geli?en Amotivasyonel Sendrom: Testosteron Ekleme Tedavisiyle Belirtileri Düzelen Bir Olgu Sunumu

Esrar, cannabis sativa adly bitkinin tohumlaryndan vekurutulmu? yapraklaryndan elde edilir, keyif verici etkisinedeniyle dünyada yaygyn olarak kullanylmaktadyr.Yapylan epidemiyolojik çaly?malarda, en az bir kez esrarkullanymy ülkeler arasynda büyük farklylyklar göstermektedir. Yngiltere'de %41, Danimarka %17, Macaristan %6,Türkiye'de %1.2-4 kullanym oranlary belirlenmi?tir. Esrarkullanym bozukluklarynyn, klinik synyflandyrylmasy vetedavisiyle ilgili bir çok çaly?ma yapylmy?tyr. Esrar kullanymyna ba?ly geli?en amotivasyonel sendrom ise klinikolarak az bilinmekte ve tedavisi ile ilgili günümüzde çokaz klinik çaly?ma bulunmaktadyr. Amotivasyonelsendrom, kronik esrar kullanymy ile ortaya çykan; enerjideazalma, motivasyon dü?üklü?ü, sosyal etkile?imsizlik,duygulanymda küntle?me, amaca yönelik aktivitelerdeazalma, zayyf muhakeme, konsantrasyon eksikli?i, bellekkusuru gibi bili?sel ve duygusal fonksiyonlarda bozulmayla seyreden bir sendromdur. Yapylan çaly?malarda, kronik esrar kullanym bozuklu?uolanlarda, motivasyon dü?üklü?ü, enerji azly?y gibi amotivasyonel sendrom klinik belirtileri %16-21 oranyndagörülmekte buna ra?men amotivasyonel sendrom, aztany konulan, ayrycy tanysy ve tedavisi konusunda çok azçaly?malaryn oldu?u bir klinik tablo olarak kar?ymyza çykmaktadyr. Tedavisinde, öncelikle altta yatan nedeninortadan kaldyrylmasy, esrar kullanymy varsa byrakylmasyönerilmektedir. Bu yazyda, kronik esrar kullanymy sonucuamtoivasyonel sendrom geli?en bir olguda, testosteronekleme tedavisiyle, klinik belirtilerinde düzelme gözlenenbir olgu sunulmaktadyr

Amotivational Syndrome Caused by Cannabis Use: A Case Who Improved with Additional Testosterone Combination Treatment

Cannabis which is obtained from seeds and dried leavesof the cannabis sativa plant is widely used in the worlddue to its recreational effect. Epidemiological studieswere suggested huge differences among countries interms of using cannabis at least once. The percentiles ofuse for countries were determined as 41% in England,17% in Denmark, 6% in Hungary, and 1.2-4% in Turkey.Lots of studies about cannabis use disorders, clinicalclassification, and treatment were conducted. However,amotivational syndrome caused by cannabis use is notonly a clinically less known phenomenon but also wehave limited clinical experience about this syndrome.Amotivational syndrome is a syndrome which is causedby cannabis use and which goes along with the cognitiveand emotional dysfunctions such as decrease in energyand motivation, lack of social interaction, apathy,decrease in goal-oriented activities, poor judgement,lack of concentration, and memory problems. In studies,it was shown that clinical symptoms of motivational syndrome such as decrease in motivation and energy in 1621% of people with cannabis use disorder was observedbut motivational syndrome emerges as a clinical phenomenon which has been diagnosed less and we have afew studies about definitive diagnosis and treatment.For treatment, it is recommended that underlying problem should be eliminated and that cannabis use shouldbe stopped.. In this article, a case which had amotivational syndrome caused by cannabis use and which hada recovery in clinical symptoms with the treatment ofadding testosterone

Kaynakça

Corcoran C, Wong ML, O'Keane V ( 2004) Bupropion in the management of apathy. J Psychopharmacol; 18 :1 33 -5.

Galynker I, Ieronimo C, Miner C ve ark. ( 1997) Methylphenidate treatment of negative symptoms in patients with dementia. J Neuropsychiatry Clin Neurosci ; 9: 231-9.

Hibell B, Andersson B, Bjarnason T ve ark. (2003) The ESPAD report. Alcohol and Other Drug Use Among Students in 35 European Countries. The Swedish Council for Information on Alcohol and Other Drugs. Stockholm; 2004.

Howlett AC, Breivogel CS, Childers SR ve ark. (2004) Cannabinoid physiology and pharmacology: 30 years of progress. Neuropharmacol ; 47: 345 -358.

Jansen IH, Olde Rikkert MG, Hulsbos HA ve ark. (2001) Toward individualized evidence-based medicine: five "N of 1" trials of methylphenidate in geriatric patients. J Am Geriatr Soc; 49: 474 -6.

Kraus MF, Maki PM ( 1997) Effect of amantadine hydrochlo- ride on symptoms of frontal lobe dysfunction in brain injury: case studies and review. J Neuropsychiatry Clin Neurosci ; 9 : 222 -230.

Kumar RN, Chambers WA, Pertwee RG. ( 2001) Pharmacological actions and therapeutic uses of cannabis and cannabinoids. Anaesthesia; 56: 1059 -68.

Leweke FM, Koethe D ( 2008) Cannabis and psychiatric disor- ders: it is not only addiction. Addict Biol; 13: 264 -275.

Marin RS, Fogel BS, Hawkins J ve ark. (1995) Apathy: a treat- able syndrome. J Neuropsychiatry Clin Neurosci ; 7: 23 -30.

McNicholas TA, Dean JD, Mulder H ve ark. (2003) A novel testosterone gel formulation normalizes androgen levels in hypogonadal men, with improvements in body composition and sexual function. BJU Int ; 91 : 69 -74.

Ozaki S, Wada K. (2001) Amotivational syndrome in organic solvent abusers. Folia Pharmacol Jpn ; 117: 42 -48.

Ögel K, U?uz ?, Syr A ve ark. (2003) Türkiye'de Ylkö?retim ve Ortaö?retim gençli?i arasynda esrar kullanym yaygynly?y. Ba?ymlylyk Dergisi; 4:15 -9.

Perry PJ, Yates WR, Williams RD ve ark. (2002) Testosterone therapy in late-life major depression in males. J Clin Psychiatry; 63:1096 -1101.

Reilly D, Didcott P, Swift W ve ark. (1998) Long-term cannabis use: characteristics of users in an Australian rural area. Addict; 93: 837-846.

Rovai L, Maremmani AG, Pacini M ve ark. (2013) Negative dimension in psychiatry. Amotivational syndrome as a paradig- ma of negative symptoms in substance abuse. Riv Psichiatry ; 48:1-9.

Seidman SN, Miyazaki M, Roose SP (2005) Intramuscular testosterone supplementation to selective serotonin reuptake inhibitor in treatment-resistant depressed men: randomized placebo-controlled clinical trial. J Clin Psychopharmacol ; 25:584- 588.

Wang C, Swerdloff RS, Iranmanesh A ve ark. (2000) Testosterone Gel Study Group. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. J Clin Endocrinol Metab ; 85:2839-2853.

Wang C, Cunningham G, Dobs A ve ark. (2004) Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab ; 89: 2085 -2098.

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