Oğuzhan HERDİ, Burak KARATAŞ, Esin GEZİCİ, Vesile ŞENTÜRK CANKORUR, Abdülkadir ÇEVİK

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SIK GÖRÜLEN RUHSAL HASTALIKLARININ TEDAVİSİNDE ANKARA ÜNİVERSİTESİ TIP FAKÜLTESİ PSİKOSOMATİK SERVİSİ UYGULAMALARI: TANIMLAYICI BİR ÇALIŞMA

Sık görülen ruhsal hastalıklar olan depresyon ve anksiyete bozuklukları toplumun %2-6’sını etkilemektedir. Sık görülen ruhsal bozuklukların tedavisinde anemi, tiroid bozuklukları genel tıbbi durumların santral sinir sistemi hastalıklarının ise klinik uygulamada akılda tutulması önemlidir. Bu çalışmada sık görülen ruhsal hasatlıklar tanısıyla izlemde olan ancak tedaviye yanıtın yetersiz olması veya yanıtın olmaması nedeniyle Ankara Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı Psikosomatik servisinde yatırılarak tedavileri düzenlenmiş hastaların dosya verileri geriye dönük olarak incelenmiştir. Çalışmanın amacı tedaviye yanıtsız bu hasta grubunun sosyo-demografik ve klinik özelliklerinin belirlenmesidir. Ankara Üniversitesi Tıp Fakültesi Psikosomatik servisine depresyon, anksiyete bozuklukları, obsesif kompulsif bozukluk, somatofom bozukluklar gibi sık görülen ruhsal hastalık tanılarıyla Eylül 2017- Haziran 2018 tarihleri arasında kabul edilen hastalar (n=60) çalışmaya alınmıştır. Hastalar 12’şerli gruplar halinde yatırılarak 2 aylık kat programı içerisinde yer alan aktiviteler ve grup ve bireysel terapiler ve ilaç tedavileri uygulanarak takip edilmiştir. Sosyodemografik veriler, anamnezden elde edilen klinik belirtiler, serum vitamin B12 ve TSH düzeyi ve kranial MR raporları analizler için kullanılmıştır. İstatiksel analizler için SPSS 21.0 kullanılmış olup p<0,05 anlamlı kabul edilmiştir. Depresif belirtiler en sık gözlenen belirti grubudur. Taciz öyküsü ile kadın cinsiyet arasında, geçmişte şiddete maruz kalmak ve depresif belirtiler arasında, ailede ruhsal hastalık varlığı ile anksiyöz belirtiler arasında anlamlı ilişki tespit edilmiş olup diğer klinik veriler ve sosyodemografik veriler arasında anlamlı ilişki tespit edilmemiştir(sırasıyla p=0,025; 0,021; 0,012). Laboratuar verileri ile diğer değişkenler arasında anlamlı bir ilişki tespit edilmemiş olup fronta beyaz cevherde hiperintensite varlığı toplam belirti sayısı ile ilişkili bulunmuştur (p=0,022). Sonuç olarak psikiyatrik hasta grubunu sadece ruhsal anlamda değil hem biyolojik yani organik hem de sosyal anlamda bütüncül bir şekilde değerlendirmek hekimlik nosyonunun bir parçası haline gelmelidir. Ancak bu şekilde bir yaklaşımla hastaların tedavisi bütüncül olarak yapılmış olacaktır. 
Anahtar Kelimeler:

Depresyon, anksiyete

MEDICAL PRACTICES OF ANKARA UNIVERSITY FACULTY OF MEDICINE PSYCHOSOMATIC UNIT IN COMMON MENTAL DISORDERS: A RETROSPECTIVE CROSS-SECTIONAL STUDY

Introduction: Depression and anxiety disorders which are counted as common mental disorders effect 2-6% of general population. In the treatment of common mental disorders, anemia, thyroid dysfunctions, general medical issues and central nervous system diseases must be kept in minds. In this paper, medical files of patients who had been hospitalized in Ankara University Faculty of Medicine, Psychosomatic Unite of Mental Health and Disorders Department cause of treatment resistance or insufficent treatment response were examinede retrospectively. Purpose of this study is identifying and sociodemographic and clinical features and exhibiting relationship between these in treatment resistant patients. Method: Patients that applied to Ankara University Faculty of Medicine Psychosomatic Unite between September 2017-June 2018 and were diagnosed as depression, anxiety disorders, obsessive-compulsive disorder or somatoform disorders were selected(n=60). Patients were hospitalized in twelve personed groups for 2 months and were treated with group and individual psychotherapies and psychotropic drugs. Sociodemographic data, clinical findings detected from medical files, serum vitamine B12 and TSH levels and cranial MRI reports were used for analysis. SPSS 21.0 was used and p<0,05 was accepted for significancy. Results: Depressive symptoms were the most observed symptoms. There were significant relationship with sexual abuse history and female sex, and physical abuse history and depressive symptoms (resptectively p=0,025; 0,021). And also there was significant relationship between anxiety symptoms and mental disorder in relatives(p=0,012). There was no relationship rest of clinical and sociodemographic data. There was no relationship between laboratuary data and the other variables but total symptom number was significantly related frontal white matter hiperintensity (p=0,022). Conclusion: In the end patient with mental disorder must be evaluated not only mental aspect but also biological and social aspects. The treatment of patients can be carried holistically if only that kind of evaluation is made.
Keywords:

Depression anxiety, psychosomatic,

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  • Afifi, T. O., Enns, M. W., Cox, B. J., Asmundson, G. J., Stein, M. B., & Sareen, J. (2008). Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. American journal of public health, 98(5), 946-952.
  • Al-Harbi, K. S. (2012). Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient preference and adherence, 6, 369.
  • Alikasifoglu, M., Erginoz, E., Ercan, O., Albayrak-Kaymak, D., Uysal, O., & Ilter, O. (2006). Sexual abuse among female high school students in Istanbul, Turkey. Child Abuse & Neglect, 30(3), 247-255.
  • Almeida, O. P., McCaul, K., Hankey, G. J., Norman, P., Jamrozik, K. and Flicker, L. (2008). Homocysteine and depression in later life. Archives of General Psychiatry, 65, 1286–1294.
  • Almeida, O. P., Ford, A. H., Hirani, V., Singh, V., McCaul, K., & Flicker, L. (2014). B vitamins to enhance treatment response to antidepressants in middle-aged and older adults: results from the B-VITAGE randomised, double-blind, placebo-controlled trial. The British Journal of Psychiatry, 205(6), 450-457.
  • Almeida, O. P., Ford, A. H., & Flicker, L. (2015). Systematic review and meta-analysis of randomized placebo-controlled trials of folate and vitamin B12 for depression. International psychogeriatrics, 27(5), 727-737.
  • Arnone, D., McIntosh, A. M., Ebmeier, K. P., Munafo, M. R., & Anderson, I. M. (2012). Magnetic resonance imaging studies in unipolar depression: systematic review and meta-regression analyses. European Neuropsychopharmacology, 22(1), 1-16.
  • Bennabi, D., Aouizerate, B., El-Hage, W., Doumy, O., Moliere, F., Courtet, P., ... & Holztmann, J. (2015). Risk factors for treatment resistance in unipolar depression: a systematic review. Journal of affective disorders, 171, 137-141.
  • Berlow, Y. A., Wells, W. M., Ellison, J. M., Sung, Y. H., Renshaw, P. F., & Harper, D. G. (2010). Neuropsychiatric correlates of white matter hyperintensities in Alzheimer's disease. International journal of geriatric psychiatry, 25(8), 780-788.
  • Besteher, B., Gaser, C., Langbein, K., Dietzek, M., Sauer, H., & Nenadić, I. (2017). Effects of subclinical depression, anxiety and somatization on brain structure in healthy subjects. Journal of affective disorders, 215, 111-117.
  • Bjelland, I., Tell, G. S., Vollset, S. E., Refsum, H., & Ueland, P. M. (2003). Folate, vitamin B12, homocysteine, and the MTHFR 677C→ T polymorphism in anxiety and depression: the Hordaland Homocysteine Study. Archives of general psychiatry, 60(6), 618-626.
  • Boeckle, M., Schrimpf, M., Liegl, G., & Pieh, C. (2016). Neural correlates of somatoform disorders from a meta-analytic perspective on neuroimaging studies. NeuroImage: Clinical, 11, 606-613.
  • Bottiglieri, T. (1996). Folate, vitamin B12, and neuropsychiatric disorders. Nutrition reviews, 54(12), 382-390.Bystritsky, A. (2006). Treatment-resistant anxiety disorders. Molecular psychiatry, 11(9), 805.
  • Clear, P. J., Vincent, J. P., & Harris, G. E. (2006). Ethnic differences in symptom presentation of sexually abused girls. Journal of Child Sexual Abuse, 15(3), 79-98.
  • Cleare, A., Pariante, C. M., Young, A. H., Anderson, I. M., Christmas, D., Cowen, P. J. … Members of the Consensus Meeting. (2015). Evidencebased guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology, 29, 459–525.
  • Cuellar, J., & Curry, T. R. (2007). The prevalence and comorbidity between delinquency, drug abuse, suicide attempts, physical and sexual abuse, and self-mutilation among delinquent Hispanic females. Hispanic Journal of Behavioral Sciences, 29(1), 68-82.
  • Delvaux, M., Denis, P., & Allemand, H. (1997). Sexual abuse is more frequently reported by IBS patients than by patients with organic digestive diseases or controls. Results of a multicentre inquiry. French Club of Digestive Motility. European journal of gastroenterology & hepatology, 9(4), 345-352.
  • Finkelhor, D., Hotaling, G., Lewis, I., & Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child abuse & neglect, 14(1), 19-28.
  • Fischer, S., & Ehlert, U. (2018). Hypothalamic–pituitary–thyroid (HPT) axis functioning in anxiety disorders. A systematic review. Depression and anxiety, 35(1), 98-110.
  • Gaynes, B. N., Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Spencer, D., & Fava, M. (2008). The STAR* D study: treating depression in the real world. Cleveland Clinic journal of medicine, 75(1), 57-66.
  • Green, R., Allen, L. H., Bjørke-Monsen, A. L., Brito, A., Guéant, J. L., Miller, J. W., ... & Ueland, P. M. (2017). Vitamin B 12 deficiency. Nature reviews Disease primers, 3, 17040.
  • Gilbody, S., Lightfoot, T. and Sheldon, T. (2007). Is low folate a risk factor for depression? A meta-analysis and exploration of heterogeneity. Journal of Epidemiology and Community Health, 61, 631–637.
  • Golding, J. M. (1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of family violence, 14(2), 99-132.
  • Hamberger, L. K., Saunders, D. G., & Hovey, M. (1992). Prevalence of domestic violence in community practice and rate of physician inquiry. Family medicine, 24(4), 283-287.
  • Herrmann, L. L., Le Masurier, M., & Ebmeier, K. P. (2008). White matter hyperintensities in late life depression: a systematic review. Journal of Neurology, Neurosurgery & Psychiatry, 79(6), 619-624.
  • Hermesh, H., Weizman, A., Shahar, A., & Munitz, H. (1988). Vitamin B12 and folic acid serum levels in obsessive compulsive disorder. Acta Psychiatrica Scandinavica, 78(1), 8-10.
  • http://temd.org.tr/admin/uploads/tbl_kilavuz/20180518105146-2018-05-18tbl_kilavuz105136.pdf
  • http://www.thd.org.tr/thdData/userfiles/file/VIT%20B.pdf
  • Inamura, K., Shinagawa, S., Nagata, T., Tagai, K., Nukariya, K., & Nakayama, K. (2015). White matter hyperintensities are associated with the severity of late-life somatoform disorders and executive functions. Nordic journal of psychiatry, 1-8.
  • Kocacık, F., Kutlar, A., & Erselcan, F. (2007). Domestic violence against women: A field study in Turkey. The Social Science Journal, 44(4), 698-720.
  • Kutluturk, F., Yildirim, B., Ozturk, B., Ozyurt, H., Bekar, U., Sahin, S., ... & Ceting, I. (2013). Thyroid dysfunctions and sonographic characteristics in northern Turkey: a population-based study. Annals of Saudi medicine, 33(3), 253.
  • Mason, G. A., Bondy, S. C., Nemeroff, C. B., Walker, C. H., & Prange Jr, A. J. (1987). The effects of thyroid state on beta-adrenergic and serotonergic receptors in rat brain. Psychoneuroendocrinology, 12(4), 261-270.
  • Mok, V. C., Wong, A., Wong, K., Chu, W. C., Xiong, Y., Chan, A. Y., ... & Wong, K. S. L. (2010). Executive dysfunction and left frontal white matter hyperintensities are correlated with neuropsychiatric symptoms in stroke patients with confluent white matter hyperintensities. Dementia and geriatric cognitive disorders, 30(3), 254-260.
  • Møllehave, L. T., Skaaby, T., Simonsen, K. S., Thuesen, B. H., Mortensen, E. L., Sandholt, C. H., ... & Linneberg, A. (2017). Association studies of genetic scores of serum vitamin B12 and folate levels with symptoms of depression and anxiety in two Danish population studies. European journal of clinical nutrition, 71(9), 1054.
  • Petridou, E. T., Kousoulis, A. A., Michelakos, T., Papathoma, P., Dessypris, N., Papadopoulos, F. C., & Stefanadis, C. (2016). Folate and B12 serum levels in association with depression in the aged: a systematic review and meta-analysis. Aging & mental health, 20(9), 965-973.
  • Taylor, M. L., Trotter, D. R., & Csuka, M. E. (1995). The prevalence of sexual abuse in women with fibromyalgia. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 38(2), 229-234.
  • Thomas, A. J., & o’Brien, J. T. (2009). Mood disorders in the elderly. Psychiatry, 8(2), 56-60.
  • Türksoy, N., Bilici, R., Yalçıner, A., Özdemir, Y. Ö., Örnek, I., Tufan, A. E., & Kara, A. (2014). Vitamin B12, folate, and homocysteine levels in patients with obsessive–compulsive disorder. Neuropsychiatric disease and treatment, 10, 1671.
  • Ullman, S. E., Filipas, H. H., Townsend, S. M., & Starzynski, L. L. (2005). Trauma exposure, posttraumatic stress disorder and problem drinking in sexual assault survivors. Journal of studies on alcohol, 66(5), 610-619.
  • Walling, M. K., Reiter, R. C., O'hara, M. W., Milburn, A. K., Lilly, G., & Vincent, S. D. (1994). Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse. Obstetrics and Gynecology, 84(2), 193-199.
  • Wang, L., Leonards, C. O., Sterzer, P., & Ebinger, M. (2014). White matter lesions and depression: a systematic review and meta-analysis. Journal of psychiatric research, 56, 56-64.
  • World Health Organization. (2005). WHO multi-country study on women's health and domestic violence against women: summary report of initial results on prevalence, health outcomes and women's responses.
  • Yang, Q. et al. Folic acid source, usual intake, and folate and vitamin B-12 status in US adults: National Health and Nutrition Examination Survey (NHANES) 2003–2006. Am. J. Clin. Nutr. 91, 64–72 (2010).
  • Yildirim, T., Yalcin, A., Atmis, V., Cengiz, O. K., Aras, S., Varlı, M., & Atli, T. (2015). The prevalence of anemia, iron, vitamin B12, and folic acid deficiencies in community dwelling elderly in Ankara, Turkey. Archives of gerontology and geriatrics, 60(2), 344-348.
  • Yazici, O. (2009). Star-D Sonrasi: Sagaltima Direnen Depresyon (SDD)/After Star-D: Treatment Resistant Depression. Noro-Psikyatri Arsivi, 46(2), 61.
Kriz Dergisi-Cover
  • ISSN: 1300-980X
  • Başlangıç: 1992
  • Yayıncı: Ankara Üniversitesi
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