Affektif hastalıklar polikliniğine başvuran olgularda katatonik belirti sıklığının ve epizodlarla ilişkisinin incelenmesi
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Katatoni saf motor belirtiler, irade bozuklukları, otonomik dengesizlik ve karmaşık motor etkinliğin bastıralamaması ile karakterize bir sendromdur. Genel olarak katatonik belirtiler saatler içerisinde belirip kaybolur, bazı belirtiler diğerlerinden daha sık görülür ve katatoniyi tanımlayacak tek bir belirti bulunmamaktadır. Katatoniye yol açan durum psikiyatrik olabileceği gibi genel tıbbi durum ile de ilişkili olabilir. Katatoni geçmişte uzun yıllar sadece şizofreni ile ilişkilendirilmekle birlikte, Kahlbaum ve ardıllarının belirttiği gibi ruhsal hastalıklardan en sık duygudurum bozukları ile ilişkilendirilmiştir (Fink, Shorter , & Taylor, 2010) (Francis, ve diğerleri, 2010) (Rosebush & Mazurek, 2010). Katatoni duygudurum bozukluklarında % 13-31 oranında görüldüğü (Caroff, Mann, Francis, & Fricchione S, 2004) halde sıklıkla belirtiler taranmamakta ve atlanmaktadır. Katatoni erken tanınarak tedavi edildiğinde mortalite riski düşmektedir. Geleneksel tanı yöntemleri yerine daha esnek ölçütler içeren ölçekler kullanıldığında yatan hastalardaki katatoni daha kolay belirlenmekte ve sıklığı % 10-25 aralığında çıkmaktadır. Literatürde bipolar bozukluk ve katatoni birlikteliği ile ilgili sınırlı sayıda çalışma olması ve var olan çalışmaların neredeyse tamamında yatan hastaların dahil edilerek yapılmış olması nedeni ile çalışmanın sonunda polikliniğe başvuran olgulardaki katatoni belirtilerinin sıklığının duygudurum dönemleriyle ve hastalık şiddetiyle ilişkisinin değerlendirilmesi amaçlanmaktadır. YÖNTEM: Çalışmaya Bipolar Bozukluk tanısıyla takipli 134 hasta dahil edilmiştir. Katılımcılara bilgilendirilmiş gönüllü onam formu imzalatılarak ayrıntılı psikiyatrik muayene yapıldıktan sonra Bush-Francis Catatonia Rating Scale (BFCRS), Kısa-Uluslararası Nöropsikiyatrik Görüşme, Klinisyen Değerlendirmesi (M.I.N.I), Young Mani Derecelendirme Ölçeği, Hamilton Depresyon Ölçeği, Ekstrapiramidal Belirtileri Değerlendirme Ölçeği (ESRS) ve 65 yaş üzeri hastalar Standardize Mini Mental Test (SMMT) uygulanmıştır. BULGULAR: BFCRS ölçeğine göre 31 hasta katatoni belirtileri olan, 103 hasta katatoni belirtileri olmayan gruba dahil edilmiştir. İki grup sosyodemografik ve hastalık özellikleri açısından karşılaştırıldığında çalışma durumu, geçirilmiş duygudurum dönemlerinde psikotik belirti görülme oranı, başvuru yeri, kullandıkları duygudurum dengeleyici ilaç, biperiden kullanım durumları, mevcut antipsikotik dozları (klorpromazin cinsinden mg/gün) açısından farklılık görülmüştür (p=0.04, p=0.001, p<0.001, p=0.04, p=0.03, p=0.02). Duygudurum dengeleyici ilaçlar ikili gruplar halinde karşılaştırıldığında ise en anlamlı fark lityum kullanımı olan ve duygudurum dengeleyici ilaç kullanımı olmayan hastalar arasında bulunmuştur (p=0.001). Beklenildiği gibi katatoni belirtileri olan grupta BFCRS, YMDÖ, CGI-BP ölçeği skorları belirgin derecede yüksek bulunmuştur (p<0.001). Hastalık şiddeti göstergeleri olan YMDÖ ve CGI-BP ölçeği ile BFCRS arasında pozitif korelasyon olduğu görülmüştür (sırasıyla kk=0.55 p<0.001, kk=0.55 p<0.001). Depresyon ve disforik mani döneminde olan olgularda BFCRS puanları daha yüksek bulunmuştur (p=0.004). Depresyon ve disforik mani döneminde olan hastalar ikili olarak karşılaştırıldığında BFCRS toplam puanlarında ESRS ölçeği karıştırıcı faktör olarak alındığında da istatistiksel olarak anlamlı farklılığın devam ettiği görülmüştür (F(2,66)=30.855, p<0.001). Karma belirtilerin varlığının BFCRS toplam puanlarını yükselttiği tespit edilmiştir (p=0.03). TARTIŞMA VE SONUÇ: Bipolar bozukluk grubunda ayaktan başvurularda katatoni sıklığının ve hastalık özellikleri ile ilişkisinin değerlendirildiği ilk çalışmadır. Bu çalışmada elde edilen bulguların, klinisyenlerin ayaktan başvurularda da katatoni ile ilgili farkındalığını arttırmak, hastalığın patofizyolojisini aydınlatmak, hangi hastada hangi tedavinin işe yarayacağını öngördürebilecek yöntemler geliştirmek açısından literatüre katkı sağlayacağı düşünülmektedir. Daha kesin bilgilere ulaşabilmek ve neden sonuç ilişkilerini açıklayabilmek için diğer katatoni nedenlerinin de dahil edildiği, daha geniş örneklemli, çok merkezli ileri çalışmalara ihtiyaç vardır.
INTRODUCTION: Catatonia is a syndrome characterized by pure motor symptoms, will disorders, autonomic imbalance and inability to suppress complex motor activity. In general, catatonic symptoms disappear within hours, some symptoms are more common than others, and there is no single symptom to describe catatonia. The condition leading to catatonia can be psychiatric or associated with the general medical condition. Although catatonia has been associated only with schizophrenia for many years in the past, it has been associated with mood disorders most commonly from mental illnesses, as Kahlbaum and his successors have pointed out (Fink, Shorter, & Taylor, 2010) (Francis, et al., 2010) (Rosebush & Mazurek, 2010). Although catatonia is seen in 13-31% of mood disorders, symptoms are often not screened and skipped (Caroff, Mann, Francis, & Fricchione S, 2004). When catatonia is diagnosed early and after that treated, the risk of mortality decreases. Using scales with more flexible criteria instead of traditional diagnostic methods, catatonia in inpatients is more easily determined and its frequency is in the range of 10-25%. There are a limited number of studies in the literature on the association of bipolar disorder and catatonia. In all existing studies were included in inpatients. At the end of the study, it is aimed to evaluate the frequency of catatonia symptoms in patients admitted to the outpatient clinic and their relationship with mood periods and disease severity. METHODS: 134 patients with a diagnosis of bipolar disorder were included in the study. A detailed psychiatric examination was performed by signing informed volunteer consent form to the participants. Then, the participants received The Mini International Neuropsychiatric Interview, Clinician Evaluation (M.I.N.I), Bush-Francis Catatonia Rating Scale (BFCRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression-Bipolar (CGI-BP), Extrapyramidal Symptoms Evaluation Scale (ESRS), Standardized Mini Mental Test (SMMT) (for the Patients over 65 years old). RESULTS: According to the BFCRS scale, 31 patients were included in the group with catatonia symptoms and 103 patients without catatonia symptoms. The two groups were compared in terms of sociodemographic and clinical characteristics. There were differences in occupational status, the rate of psychotic symptoms seen in previous mood episodes, terms of application, the use of mood stabilizer, use of biperiden and current antipsychotic medication doses (mg / day in chlorpromazine) (p=0.04, p=0.001, p<0.001, p=0.04, p=0.03, p=0.02, respectively). When mood stabilizers are compared in pairs, the most significant difference was found among patients with lithium use and no mood stabilizer use (p=0.001). As expected, in the group with symptoms of catatonia, BFCRS, YMRS, CGI-BP scale scores were found higher than non-catatonic patients (p<0.001). Regarding the indicators of disease severity, there was a positive correlation between YMRS and CGI-BP scale, and BFCRS scores (respectively, kk=0.55 p<0.001, kk=0.55 p<0.001). BFCRS scores were higher in patients with depression and dysphoric mania (p=0.004).When the patients with depression and dysphoric mania were compared in pairs, it was observed that the statistically significant difference remained in the BFCRS total scores when the ESRS scale was taken as a confounding factor (F(2,66)=30.855, p<0.001). It was determined that the presence of mixed symptoms increased the BFCRS total scores (p=0.03). DISCUSSION AND CONCLUSION: This is the first study to evaluate the frequency of catatonia and its relationship with disease characteristics in outpatient applications in bipolar disorder group. The situations in which the findings obtained in this study will contribute to the literature are as follows; Increasing the awareness of clinicians about catatonia in outpatient applications, to illuminate the pathophysiology of the disease and also developing methods that can predict which treatment will work in which patient.In order to reach more precise information and to explain the cause and effect relationships, there is a need for further studies with larger samples and multicentre, including other causes of catatonia.
INTRODUCTION: Catatonia is a syndrome characterized by pure motor symptoms, will disorders, autonomic imbalance and inability to suppress complex motor activity. In general, catatonic symptoms disappear within hours, some symptoms are more common than others, and there is no single symptom to describe catatonia. The condition leading to catatonia can be psychiatric or associated with the general medical condition. Although catatonia has been associated only with schizophrenia for many years in the past, it has been associated with mood disorders most commonly from mental illnesses, as Kahlbaum and his successors have pointed out (Fink, Shorter, & Taylor, 2010) (Francis, et al., 2010) (Rosebush & Mazurek, 2010). Although catatonia is seen in 13-31% of mood disorders, symptoms are often not screened and skipped (Caroff, Mann, Francis, & Fricchione S, 2004). When catatonia is diagnosed early and after that treated, the risk of mortality decreases. Using scales with more flexible criteria instead of traditional diagnostic methods, catatonia in inpatients is more easily determined and its frequency is in the range of 10-25%. There are a limited number of studies in the literature on the association of bipolar disorder and catatonia. In all existing studies were included in inpatients. At the end of the study, it is aimed to evaluate the frequency of catatonia symptoms in patients admitted to the outpatient clinic and their relationship with mood periods and disease severity. METHODS: 134 patients with a diagnosis of bipolar disorder were included in the study. A detailed psychiatric examination was performed by signing informed volunteer consent form to the participants. Then, the participants received The Mini International Neuropsychiatric Interview, Clinician Evaluation (M.I.N.I), Bush-Francis Catatonia Rating Scale (BFCRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression-Bipolar (CGI-BP), Extrapyramidal Symptoms Evaluation Scale (ESRS), Standardized Mini Mental Test (SMMT) (for the Patients over 65 years old). RESULTS: According to the BFCRS scale, 31 patients were included in the group with catatonia symptoms and 103 patients without catatonia symptoms. The two groups were compared in terms of sociodemographic and clinical characteristics. There were differences in occupational status, the rate of psychotic symptoms seen in previous mood episodes, terms of application, the use of mood stabilizer, use of biperiden and current antipsychotic medication doses (mg / day in chlorpromazine) (p=0.04, p=0.001, p<0.001, p=0.04, p=0.03, p=0.02, respectively). When mood stabilizers are compared in pairs, the most significant difference was found among patients with lithium use and no mood stabilizer use (p=0.001). As expected, in the group with symptoms of catatonia, BFCRS, YMRS, CGI-BP scale scores were found higher than non-catatonic patients (p<0.001). Regarding the indicators of disease severity, there was a positive correlation between YMRS and CGI-BP scale, and BFCRS scores (respectively, kk=0.55 p<0.001, kk=0.55 p<0.001). BFCRS scores were higher in patients with depression and dysphoric mania (p=0.004).When the patients with depression and dysphoric mania were compared in pairs, it was observed that the statistically significant difference remained in the BFCRS total scores when the ESRS scale was taken as a confounding factor (F(2,66)=30.855, p<0.001). It was determined that the presence of mixed symptoms increased the BFCRS total scores (p=0.03). DISCUSSION AND CONCLUSION: This is the first study to evaluate the frequency of catatonia and its relationship with disease characteristics in outpatient applications in bipolar disorder group. The situations in which the findings obtained in this study will contribute to the literature are as follows; Increasing the awareness of clinicians about catatonia in outpatient applications, to illuminate the pathophysiology of the disease and also developing methods that can predict which treatment will work in which patient.In order to reach more precise information and to explain the cause and effect relationships, there is a need for further studies with larger samples and multicentre, including other causes of catatonia.
Açıklama
Anahtar Kelimeler
Bipolar Bozukluk, Katatoni, Depresyon, Mani, Karma Belirti, Bipolar Disorder, Catatonia, Depression, Mania, Mixed Symptoms
