Bipolar bozukluk bir yıllık izlem çalışması

Amaç: Bu çalışmada, remisyonda olan bipolar hastaların bir yıl süreyle takibi ile hastalığın gidiş özellikleri ve sonuçlarının ele alınması amaçlanmıştır. Yöntem: Bu çalışmada altı ayda bir, toplam üç kez değerlendirilmiş 48 hastanın verileri ele alınmıştır. Çalışma başında iyilik döneminde olan bu hastaların hepsine Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi (Schedule for Affective Disorders and Schizophrenia / SADS) verilmiş, kontrolleri aynı çizelgenin izlem Formu ile yapılmış, tüm görüşmelerde Genel Değerlendirme Ölçeği (Global Assessment Scale / GAS), Yaşamdan Hoşnutluk ve Doyum Kalitesi Ölçeği (Ouality of Life Enjoyment and Satisfaction Questionnaire), Kısa Yetiyitimi Anketi ve Tedavi İzlem Formu verilmiştir. Bulgular: Psikososyal bozukluğu değerlendiren ölçeklerde düzelme olduğu, belirti gruplarının çoğunda ise istatistik-sel anlamlılığa ulaşan değişiklik olmadığı tespit edilmiştir. Birinci sene sonunda örneklemin %31.2'sinde hastalığın tekrarladığı gözlenmiştir. Örneklem GAS ortalamalarına göre iyi, orta, kötü gidiş gruplarına ayrılmış; iyi gidiş grubunda kötü gidiş grubuna göre daha az kalıntı belirti olduğu, yalnızca lityumla daha yüksek oranda koruma sağlanabildiği tespit edilmiştir. İzlem sonundaki GAS puanının ara dönem kalıntı depresyon belirtileri ile yordanabildiği bulunmuştur. Sonuç: Örneklemimizde, hastalık tekrarı literatürde bildirilen oranlara göre düşük bulunmuştur. Ara dönem depresyon belirtileri ve yalnızca lityum ile koruma sağlanamaması kötü seyir ile bağlantılı bulunmuştur.

Bipolar disorder one year follow up

Objective: Bipolar disorder is known to involve multiple relapses and impaired psychosocial functioning, and is best examined by naturalistic assessments. The aim of this study was to investigate the course and outcome of bipolar disorder in a one-year naturalistic follow-up of interepisode patients. Method: The data of 48 patients, who were evaluated once every 6 months a total of three times, was analysed. interepisode bipolar patients were first interviewed with the Schedule for Affective Disorders and Schizophrenia (SADS), during follow-up with the SADS-Change version and at every session with Global Assessment Scale, the Quality of Life Enjoyment and Satisfaction Questionnaire, the Brief Disability Questionnaire and a form for the follow-up of that treatment Results: There were no statistically significant changes in most symptom scores but there was a positive change in psychosocial scale scores. The relapse rate after one year was 31.2%. interepisode symptom levels and the success of maintenance lithium monotherapy differed significantly between GAS-based good, medium and bad course groups. interepisode depressive symptoms could predict the GAS at the end of the follow-up. Conclusion: The relapse rate of our sample was relatively low compared to earlier reports. interepisode depressive symptoms and the failure of maintenance lithium monotherapy were associated with a less favourable course.

Kaynakça

Blazer DG, George LK, Landerman L ve ark (1985) Psychiatric disorders: a rural/urban comparison. Arch Gen Psychiatry, 42: 651-656.

Coryell W, Scheftner W, Keller M ve ark (1993) The enduring psychosocial consequences of mania and depression. Am J Psychiatry, 150: 720-727.

Coryell W, Turvey C, Endicott J ve ark (1998) Bipolar I affective disorder: predictors of outcome after 15 years. J Affect Disord, 50: 109-116.

Deister A, Marneros A (1993) Predicting the long-term outcome of affective disorders. Acta Psychiatr Scand, 88:174-177.

Endicott J, Spitzer RL, Fleis JL ve ark (1976) The global assessment scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry, 33:776-771.

Endicott J, Nee J, Harrison W ve ark (1993) Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacology Bulletin, 29:321-326.

Fenning S, Bromer EJ, Karant MT ve ark (1996) Mood-congruent versus mood-incongruent psychotic symtoms in first-admission patients with affective disorder. J Affect Disord, 37:23-29.

Gitlin MJ, Swendsen J, Heller TL ve ark (1995) Relapse and impairment in bipolar disorder. Am J Psychiatry, 152: 1635-1640.

Goldberg JF, Harrow M, Grossman LS (1995) Course and outcome in bipolar affective disorder: a longitudinal follow-up study. Am J Psychiatry, 152: 379-384.

Goldberg JF, Harrow M (1999) Poor-outcome bipolar disorders. Bipolar Disorders: Clinical Course and Outcome, Goldberg JF, Harrow M (Ed), Washington DC, American Psychiatric Press Inc, s. 1-19.

Goldberg JF, Keck PE (1999) Summary of findings on the course and outcome of bipolar disorders. Bipolar Disorders: Clinical Course and Outcome, Goldberg JF, Harrow M (Ed), Washington DC, American Psychiatric Press Inc, s. 275-289.

Harrow M, Goldberg JF, Grosman LS ve ark (1990) Outcome in manic disorders: a naturalistic follow-up study. Arch Gen Psychiatry, 47:665-671.

Kaplan İ (1995) Yarı kırsal alanda bir sağlık ocağına başvuran hastalarda ruhsal bozuklukların yetiyitimi ile ilişkisi. Türk Psikiyatri Dergisi, 6(3): 169-179.

Keck PE Jr, Mc Elroy SL, Strakowski SM ve ark (1998) 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. Am J Psychiatry, 155:645-652.

Keller M, Lavori P, Coryell W ve ark (1986) Differential outcome of episodes of illness in bipolar patients. Pure manic, mixed/cycling, and pure depressive. JAMA, 255:3138-3142.

Keller MB, Lavori PW, Coryell W ve ark (1993) Bipolar I, a five-year prospective follow-up. Journal of Nervous and Mental Disorders, 181:238-245.

Mander AJ (1986) Clinical prediction of outcome and lithium response in bipolar affective disorder. J Affect Disord, 11:35-41.

Mintz J, Mintz LI, Arruda MJ ve ark (1992) Treatment of depression and the functional capacity to work. Arch Gen Psychiatry, 49:761-768.

O’Connel RA, Mayo JA, Flatlow L ve ark (1991) Outcome of bipolar disorder on long term treatment with lithium. Br J Psyhiatry, 159: 123-129.

Özerdem A, Tunca Z, Kaya N (2001) The relatively good prognosis of bipolar disorders in a Turkish bipolar clinic. J Affect Disord, 64: 27-34.

Saka MC, Uluşahin A, Batur S ve ark (1998) Duygulanımbozuklukları ve şizofreni görüşme çizelgesi. Türkçe formu güvenirlik çalışması. Türk Psikiyatri Dergisi, 9(4):265-268.

Solomon DA, Ristow R, Keller MB ve ark (1996) Serum lithium levels and psychosocial function in patients with bipolar I disorder. Am J Psychiatry, 153: 1301-1307.

Spitzer RL, Gibbon M, Endicott J (1976) The Global Assessment Scale. Arch Gen Psychiatry, 33:768.

Spitzer RL, Endicott J (1978) Schedule for Affective Disorders and Schizophrenia. New York, Biometric Research, New York State Psychiatric Institute.

Stewart AL, Hays RD, Ware JEJ (1988) The MOS short form general health survey: reliability and validity in a patient population. Med Care, 26:724-735.

Strakowski SM, Keck PE Jr, Mc Elroy SL ve ark (1998) Twelve-month outcome after a first hospitalization for affective psychosis. Arch Gen Psychiatry, 55:49-55.

Tarlov AR, Ware JE, Greenfield S ve ark (1989) The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA, 262(7):925-30.

Tohen M, Walternaux CM, Tsuang MT (1990) Outcome in mania: a 4 year prospective follow-up of 75 patients utilizing survival analysis. Arch Gen Psychiatry, 47:1106-1111.

Tohen M, Stoll AL, Strakowski SM ve ark (1992) Prediction of outcome in mania by mood-congruent or mood-incongruent psychotic features. Am J Psychiatry, 149:1580-1584.

Turvey CL, Coryel WH, Arndt S ve ark (1999a) Polarity sequence, depression and chronicity in bipolar I disorder. J Nerv Ment Dis, 187: 181-187.

Turvey CL, Coryel WH, Solomon DA ve ark (1999b) Long-term prognosis of bipolar I disorder. Acta Psychiatr Scand, 99: 110-119.

Uluşahin A, Kara S, Batur S ve ark (2000) Duygulanım bozuklukları ve şizofreni görüşme çizelgesi: Türkçe formu geçerlik ve güvenirlik çalışması. Psikiyatri Psikoloji Psikofarmakoloji Dergisi, 8(2):100-105.

Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Med Care, 30(6):473-83.

Weissman MM, Bruce ML, Leaf PJ ve ark (1991) Psychiatric disorders in America. L Robins, D Regier (ed) New York, Free Press, s 53-81.

Winokur G, Coryel W, Akiskal HS ve ark (1994) Manic-depressive (bipolar) disorder: the course in light of a prospective ten-year follow-up of 131 patients. Acta Psychiatr Scand, 89:102-110.

Winokur G (1999) Alcoholism in bipolar disorder. Bipolar Disorders: Clinical Course and Outcome, Goldberg JF, Harrow M (Ed), Washington DC, American Psychiatric Press Inc, s. 185-197.

Yazıcı O, Kora K, Üçok A ve ark (1999) Predictors of lithium prophylaxis in bipolar disorder. Journal of Affective Disorders, 55:133-142.

Kaynak Göster