Ayşe Rümeysa YAMAN, Duru KUZUGÜDENLİOĞLU ULUSOY, Feyza DÖNMEZ

BİPOLAR BOZUKLUĞU OLAN HASTALARIN MİZAÇ VE BAĞLANMA ÖZELLİKLERİ İLE OKSİTOSİN DÜZEYLERİ ARASINDAKİ İLİŞKİNİN ARAŞTIRILMASI

Amaç Bu çalışmanın amacı bipolar bozukluğu (BPB) olan erkek olgularda bağlanma biçimlerini ve bu bağlanma biçimlerinin mizaç özellikleri ve oksitosin ile ilişkisini araştırmaktır. Bu amaç doğrultusunda bipolar bozuk luk hastalarının bağlanma biçimiyle mizaç ve oksito sin arasındaki ilişkinin sağlıklı bireylerle karşılaştırıla rak incelenmesi hedeflenmiştir. Gereç ve Yöntem Bu çalışmaya 30 bipolar bozukluk tanılı erkek hasta ve 30 erkek kontrol grubu dâhil edilmiştir. Psikiyatri polikliniğinde izlenen hastalarda 18 yaşın üzerinde ol mak, metabolik veya endokrin hastalığın olmaması, remisyon döneminde (ötimi) olmak şartları aranmıştır. Tanı görüşmesi DSM-IV Eksen I Bozuklukları için Ya pılandırılmış Klinik Görüşme (SCID-I) ile yapılmıştır. Mizaç değerlendirilmesi TEMPS-A mizaç ölçeği ile, bağlanma değerlendirilmesi Erişkin Bağlanma Biçimi Ölçeği (EBBÖ) kullanılarak yapılmış, serum oksitosin düzeyi ELISA yöntemi ile ölçülmüştür. Bulgular BPB olgularda güvensiz bağlanmanın sağlıklı birey lerde olduğundan daha sık olduğu bulunmuştur. BPB olguların kaçıngan ve kaygılı/ikircikli bağlanma puan ları sağlıklı kontrollerden yüksek bulunmuştur. Kont rol grubunda güvensiz bağlanan bireylerin siklotimik mizaç puanlarının daha yüksek olduğu saptanmıştır. BPB olgular ve kontrol grubu bireylerinde bağlanma biçimi puanları ile serum oksitosin düzeyi arasında ilişki bulunamamıştır. Her iki grup için medeni durum, eğitim durumu, aile durumu, yetiştiği ortam (kimlerin yanında yetiştiği) değişkenleri ile güvenli veya güven siz bağlanmalar arasında fark gösterilememiştir. Sonuç Çalışma sonucunda BPB’de kaçıngan ve kaygılı/ikir cikli bağlanma puanlarının sağlıklı kontrollerden yük sek olduğu, güvensiz bağlanma biçimi ile duygudurum bozukluklarının karşılıklı ve çift yönlü olarak birbirini olumsuz etkilediği anlaşılmıştır. BPB olgularda siklo timik mizaç güvensiz bağlanmayı artırmaktadır. Bağ lanma biçimi puanları ile oksitosin düzeyleri arasında ilişkinin olmaması bunun yanında olguların sendromal veya subsendromal afektif patolojilere sahip olması bağlanma üzerine etkide mizaç özelliklerinin belirle yici olduğunu akla getirmektedir. Her ne kadar mizaç özellikleri ve oksitosinin bağlanma üzerine olan etki lerini inceleyen araştırmalar olsa da, çalışmamız bu kavramların ikili olarak bağlanma biçimine etkilerinin aynı anda incelendiği ilk çalışma olmuştur.

THE RELATIONSHIP BETWEEN ATTACHMENT STYLES AND TEMPERAMENT AND OXYTOCIN LEVELS IN BIPOLAR PATIENTS

Objective The aim of the present study is to investigate the atta chment styles in male bipolar disorder (BPD) patients and the relationship of these attachment styles with temperament and oxytocin levels. Accordingly the re lation of the attachment styles of bipolar cases with temperament and oxytocin levels are examined by comparing them to the healthy controls. Material and Methods Thirty male patients with bipolar disorder and 30 male healthy control subjects are recruited. Inclusion crite ria consists of being over 18 years of age, not having a metabolic or an endocrine disorder, and to be in re mission with regard to BPD. Diagnostic interview was made with Structured Clinical Interview for DSM-Axis 1 Disorders (SCID-I). Temperament was evaluated with TEMPS-A and attachment style was evaluated by the Adult Attachment Scale (AAS). Plasma oxyto cin levels were evaluated with ELISA. Results It was found that insecure attachment was more frequent in BPD cases than the healthy group. Avo idant and anxious/ambivalent attachment scores of bipolar cases were higher than the control group. In control group individuals with insecure attachment, cyclothymic temperament scores were higher than the bipolar cases. There was no significant relation between attachment style and oxytocin levels in both groups.There was no significant difference in the at tachment styles with regard to marital status, educa tion level, family, hometown environment (with whom he/she was grown up with ). Conclusions The results showed that avoidant and anxious / am bivalent attachment scores in BPD were higher than healthy controls, and that insecure attachment style and mood disorders affected exert a negative recipro cal effect on each other. Cyclothymic temperament increases insecure attachment in patients with BPD. Absence of association betweeen attachment sco res and plasma oxytocin levels and presence of sy ndromal or subsyndromal affective pathology in BPD suggest that affective temperament features may be more important for attachment styles.Although there are studies investigating the temperament properties and the effects of oxytocin on attachment as seperate factories, our study is the first study that examine the combined effect of these variable with respect to each other on attachment.

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