ERGENLERDE BİPOLAR BOZUKLUK: TEDAVİ STRATEJİLERİ VE EŞ TANILAR

Yıl 2018, Cilt: 26 Sayı: 2, 0 - 0, 28.08.2018

Ece Ağtaş Ertan , Bedriye Öncü Çetinkaya

Öz

Giriş: Bipolar bozukluk, genç nüfusta bilişsel ve fonksiyonel bozukluklar, intihar girişimleri gibi sonuçları nedeniyle önemli bir morbidite ve mortalite nedenidir. Erişkinlikte bipolar bozukluk tanısı konulan olguların genellikle ilk olarak ergenlik döneminde şikayetlerinin başladığı bilinmektedir. Ergen yaş grubunda tanınması ve tedavisi önemli olan bu bozukluğun kliniğimiz Ergen Ünitesinde eş tanı ve tedavi stratejilerini incelemeyi amaçladık. Yöntem: Ankara Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı Ergen Ünitesi polikliniğine Haziran 2016-Mayıs 2017 tarihleri arasında ayaktan başvuran bipolar bozukluk tanılı olguların dosyaları retrospektif olarak taranmıştır. Olguların eştanıları ve aldıkları tedaviler gözden geçirilmiş, veriler arasındaki ilişkiler istatistiksel analizler ile değerlendirilmiştir. Sonuçlar: 31 kadın (%66, yaş ort: 19,48), 16 erkek (%34, yaş ort: 18,94) olmak üzere 47 olgu çalışmaya dahil edilmiştir. Eş tanı sıklığı %59,6 olup, en sık eş tanılar; dikkat eksikliği ve hiperaktivite bozukluğu, mental retardasyon ve obsesif kompulsif bozukluktur. Olguların %87,2'si duygudurum düzenleyici, % 93,6'sı antipsikotik, %19,1’i antidepresan kullanmaktadır. Eş tanı varlığında çoklu ilaç kullanımının anlamlı derecede fazla olduğu saptanmıştır. Tartışma: Ergen bipolar bozuklukta örneklemimizde eş tanı ve çoklu ilaç kullanım oranlarının yüksek olduğu görülmektedir. Ergenlerde tanının zorluğu, ilaç tedavisi alan ergenlerin genellikle şiddetli belirtileri ve eşlik eden bozukluklarının olması bu durum üzerinde etkili olabilir.

Anahtar Kelimeler

ergen, bipolar bozukluk, eştanı, tedavi, dehb, psikostimülan

BIPOLAR DISORDER IN ADOLESCENTS: TREATMENT STRATEGIES AND COMORBIDITIES

Öz

Introduction: Bipolar disorder is an important cause of morbidity and mortality because of its consequences such as cognitive/functional disorders and suicide attempts. Most of the cases that diagnosed as bipolar disorder in adulthood are known to have the symptoms since adolescence. Since recognition and treatment of this disorder is crucial in adulthood, we aim to investigate the comorbidities and treatment strategies of bipolar disorder in Adulthood Unit in our clinic. Method: The folders of the patients who admitted the Ankara University Department of Psychiatry Adulthood Outpatient Clinic between June 2016-May 2017 and diagnosed as bipolar disorder are searched retrospectively. Comorbidities and treatments of these patients are investigated, the relations between this data are analyzed with statistical analyses. Results: 47 cases; 31 female (66%, mean age: 19,48), 16 male (34%, mean age: 18,94) are included in the study. The rate of comorbidity is 59,6%, the most common comorbidities are; attention deficit and hyperactivity disorder, mental retardation and obsessive-compulsive disorder. 87,2% of the cases use mood stabilizer, 93,6% use antipsychotic drugs and 19,1% use antidepressants. Multiple drug use is significantly greater in the cases with comorbidities. Discussion: In our sample with adulthood bipolar disorder, the rates of comorbidity and multiple drug use are high. The difficulty of diagnosing in adolescents, the adolescents that use pharmacological treatment being the ones that have more severe symptoms and comorbidities may be the reason for these results.

Anahtar Kelimeler

Adolescent, bipolar disorder, comorbidity, adhd, psychostimulan

Kaynakça

• Birmaher, B. (2013). Bipolar disorder in children and adolescents. Child and Adolescent Mental Health, 18(3), 140–148.
• Birmaher, B., Axelson, D., Goldstein, B., Strober, M., Gill, M. K., Hunt, J., … Kim, E. (2009). Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the Course and Outcome of Bipolar Youth (COBY) study. American Journal of Psychiatry, 166(7), 795–804.
• Carlson, G. A., Loney, J., Salisbury, H., Kramer, J. R., & Arthur, C. (2000). Stimulant treatment in young boys with symptoms suggesting childhood mania: a report from a longitudinal study. Journal of Child and Adolescent Psychopharmacology, 10(3), 175–184.
• Delbello, M. P., Schwiers, M. L., Rosenberg, H. L., & Strakowski, S. M. (2002). A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. Journal of the American Academy of Child & Adolescent Psychiatry, 41(10), 1216–1223.
• Diler, R. S., Uguz, S., Seydaoglu, G., Erol, N., & Avci, A. (2007). Differentiating bipolar disorder in Turkish prepubertal children with attention-deficit hyperactivity disorder. Bipolar Disord, 9(3), 243–251.
• Duffy, A. (2009). The early course of bipolar disorder in youth at familial risk. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 18(3), 200.
• Evans-Lacko, S. E., Zeber, J. E., Gonzalez, J. M., & Olvera, R. L. (2009). Medical comorbidity among youth diagnosed with bipolar disorder in the United States. Journal of Clinical Psychiatry, 70(10), 1461–1466.
• Frías, Á., Palma, C., & Farriols, N. (2015). Comorbidity in pediatric bipolar disorder: prevalence, clinical impact, etiology and treatment. Journal of Affective Disorders, 174, 378–389.
• Galanter, C. A., Carlson, G. A., Jensen, P. S., Greenhill, L. L., Davies, M., Li, W., … March, J. S. (2003). Response to methylphenidate in children with attention deficit hyperactivity disorder and manic symptoms in the multimodal treatment study of children with attention deficit hyperactivity disorder titration trial. Journal of Child and Adolescent Psychopharmacology, 13(2), 123–136.
• Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561–1572.
• Kafantaris, V., Coletti, D. J., Dicker, R., Padula, G., & Kane, J. M. (2001). Adjunctive antipsychotic treatment of adolescents with bipolar psychosis. Journal of the American Academy of Child & Adolescent Psychiatry, 40(12), 1448–1456.
• Khazanov, G. K., Cui, L., Merikangas, K. R., & Angst, J. (2014). Treatment Patterns of Youth with Bipolar Disorder: Results from the National Comorbidity Survey—Adolescent Supplement (NCS-A). Journal of Abnormal Child Psychology, 43(2), 391–400.
• Kowatch, R. A., Fristad, M., Birmaher, B., Wagner, K. D., Findling, R. L., & Hellander, M. (2005). Treatment guidelines for children and adolescents with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44(3), 213–235.
• Kowatch, R. A., Sethuraman, G., Hume, J. H., Kromelis, M., & Weinberg, W. A. (2003). Combination Pharmacotherapy in Children and Adolescents with Bipolar Disorder. Society of Biological Psychiatry, 53(3), 978–984.
• Krieger, F. V., & Stringaris, A. (2013). Bipolar disorder and disruptive mood dysregulation in children and adolescents: Assessment, diagnosis and treatment. Evidence-Based Mental Health, 16(4), 93–94.
• Lus, G., & Mukaddes, N. M. (2009). Co-morbidity of bipolar disorder in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in an outpatient Turkish sample. World Journal of Biological Psychiatry, 10(4 PART 2), 488–494.
• Martin, A., Volkmar, F. R., & Lewis, M. (2007). Lewis’s child and adolescent psychiatry: a comprehensive textbook. Lippincott Williams & Wilkins.
• Masi, G., Perugi, G., Toni, C., Millepiedi, S., Mucci, M., Bertini, N., & Pfanner, C. (2006). Attention-deficit hyperactivity disorder - Bipolar comorbidity in children and adolescents. Bipolar Disorders, 8(4), 373–381.
• Masi, G., Toni, C., Perugi, G., Mucci, M., Millepiedi, S., & Akiskal, H. S. (2001). Anxiety Disorders in Children and Adolescents with Bipolar Disorder: A Neglected Comorbidity. The Canadian Journal of Psychiatry, 46(9), 797–802.
• Masi, G., Toni, C., Perugi, G., Travierso, M. C., Millepiedi, S., Mucci, M., & Akiskal, H. S. (2003). Externalizing Disorders in Consecutively Referred Children and Adolescents With Bipolar Disorder, 44(3), 184–189.
• McClellan, J., Kowatch, R., & Findling, R. L. (2007). Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), 107–125.
• Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry, 70(3), 300–310.
• Scheffer, R. E., Kowatch, R. A., Carmody, T., & Rush, A. J. (2005). Randomized, placebo-controlled trial of mixed amphetamine salts for symptoms of comorbid ADHD in pediatric bipolar disorder after mood stabilization with divalproex sodium. American Journal of Psychiatry, 162(1), 58–64.
• Tillman, R., Geller, B., Bolhofner, K., Craney, J. L., Williams, M., & Zimerman, B. (2003). Ages of onset and rates of syndromal and subsyndromal comorbid DSM-IV diagnoses in a prepubertal and early adolescent bipolar disorder phenotype. Journal of the American Academy of Child and Adolescent Psychiatry, 42(12), 1486–1493.