Otizm spektrum bozukluğu olan hastalarda semptom ve semptom şiddetinin seyri ve ı?lişkili bireysel ve ailesel faktörler
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Otizm Spektrum Bozukluğu (OSB); belirtilerinin hayatın ilk yıllarından itibaren görülmeye başladığı, iletişim kurma ve sürdürme ve sosyal becerilerde yetersizlik, aynılıkta ısrarcı olma , sınırlı ilgi alanı ve tekrarlayıcı davranışların olduğu ve etkileri hayat boyu devam eden nörogelişimsel bir bozukluktur. Hastalık sırasında gözlenen birçok faktör hastalık seyri ve prognozu için önem arzetmektedir. Olumlu sonuçlarla ilişkili faktörler arasında yüksek bilişsel işlev, ortak dikkatin varlığı, hafif OSB semptomlarının varlığı, akranlarla sosyalleşme eğilimi, işlevsel oyun becerileri ve erken teşhis yer almaktadır. Bağımsız yaşam standartlarına ulaşma, akademik başarı, sosyal ilişkiler ve arkadaşlıklar dahil olmak üzere birçok alanda zorluk yaşayan OSB'li bireylerin semptomlarının seyrinin değerlendirilmesi ve bu süreçte uygun önlemlerin alınması, hem kendileri hem aileleri açısından önem arzetmektedir. Amaç: Bu çalışmada kliniğimizde 2016 yılında OSB tanılı hastalarla yapılan bir çalışmadaki hastalara tekrar ulaşılarak yıllar içerisindeki hastalık şiddetinin karşılaştırılması ve bu hastalardaki semptom şiddeti ve semptomların gelişimsel seyri ile ilişkili bireysel ve ailesel faktörlerin değerlendirilmesi amaçlanmıştır. Yöntem ve Gereçler: 2016 yılındaki OSB tanılı 100 hastadan 64'üne ulaşılmış ve K-SADS ile DSM-5'e göre psikiyatrik muayeneleri yapılmıştır. Bu olgularda Çocukluk Otizmi Değerlendirme Ölçeği (Childhood Autism Rating Scale- CARS), DSM-5 Klinisyen Tarafindan Puanlanan Otizm Spektrum ve Toplumsal İletişim Bozukluğu Şiddeti Ölçeği, Otizm Davranış Kontrol Listesi (Autism Behavior Checklist - ABC), Otizm Sosyal Beceriler Profili (OSBP) ve Sosyal Cevaplılık Ölçeği (Social Responsiveness Scale - SRS) kullanılmıştır. Ayrıca ebeveynlerin Kısa semptom envanteri (KSE), Kısa işlevsellik değerlendirme ölçeği, Empati ölçeği(EQ) ve Ebeveyn-çocuk ilişkisi ölçeklerini doldurmaları istenmiştir. Bulgular: Yapılan değerlendirmelerde 64 hastadan 11'inin OSB tanı kriterlerini artık karşılamadığı görülmüştür. OSB grubunun tanı kaybı grubuna göre daha fazla psikiyatrik komorbiditeye sahip olduğu ve daha çok psikofarmakolojik tedavi kullandığı saptanmıştır. OSBP puanlarında tanı kaybı grubunun daha yüksek puanlar aldığı görülmüştür. Ayrıca ebeveynlere uygulanan KİDÖ ve KSE ölçeklerinde OSB tanılı grupta daha yüksek puanlar saptanmıştır. Benzer şekilde ebeveynlere uygulanan EÖ ve EÇİÖ olumlu puanlarında tanı kaybı grubunda önemli ölçüde daha yüksek puanlar elde ettikleri görülmüştür. Tanı kaybı VII grubunun OSB tanısını karşıladıkları dönemdeki ÇODÖ puanlarının, OSB tanılı gruba göre daha düşük olduğu saptanmıştır. OSB tanılı olgularda, ÇODÖ puanlarının 2016 ve günümüzde uygulanan sonuçları arasında anlamlı farklılık bulunmamıştır. Ayrıca Çalışmamızda 53 OSB tanılı olgunun 45'inde eşlik eden entelektüel yeti yitimi tanısı olduğu, OSB tanı kaybı grubunda ise entelektüel yeti yitimi bulunmadığı saptanmıştır. Sonuç: Yapılan bu çalışma ile OSB tanılı bireylerin uzun dönemde de tanılarının devam ettiği ve tanıyı kaybeden bireylere göre daha çok komorbid psikopatolojilere sahip olduğu gösterilmiştir. Ayrıca OSB tanılı bireylerin ailelerindeki işlevsellik düzeyinin ve empati becerilerinin daha düşük olduğu saptanmıştır. Bu olguların ilerleyen dönemdeki klinik gidişatı ve sosyal, akademik ve aile ilişkilerindeki işlevselliklerinin arttırılması için erken tanının önemiyle birlikte olgulara yapılacak müdahale yöntemlerinin kapsamı ve kalitesinin de arttırılması gerekmektedir. Sonuç olarak bu olguların uzun dönem psikiyatrik izleminde detaylı ruh sağlığı değerlendirmesine ek olarak ailelerinin de değerlendirilmesi ve müdahale programları kapsamına alınması klinik ve sosyal açıdan faydalı olabilecektir. Anahtar Kelimeler: otizm; prognoz; tanı kaybı; ailesel faktörler
Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder whose symptoms begin in the first years of life, and include inadequacy in establishing and maintaining communication and social skills, insistence on sameness, limited range of interests, and repetitive behaviors, and its effects last throughout life. Many factors observed during the disease are important for the course and prognosis of the disease. Factors associated with positive outcomes include higher cognitive function, presence of joint attention, presence of mild ASD symptoms, tendency to socialize with peers, functional gaming skills, and early diagnosis. Evaluating the course of symptoms of individuals with ASD who have difficulties in many areas, including reaching independent living standards, academic success, social relations, and friendships, and taking appropriate precautions in this process may be beneficial for both themselves and their families. Objective: In this study, we aimed to compare the severity and developmental course of symptoms in patients diagnosed with ASD in our clinic in 2016, while also evaluating the individual and familial factors associated with symptom severity. Method: 64 out of 100 patients diagnosed with ASD in 2016 were reached and psychiatric examinations were performed according to K-SADS and DSM-5. In these cases, the Childhood Autism Rating Scale (CARS), The Clinician-Rated Severity of Autism Spectrum and Social Communication Disorders, Autism Behavior Checklist (ABC), Autism Social Skills Profile (ASSP), and Social Responsiveness Scale (SRS) scales were used. In addition, parents were asked to fill out the Brief Symptom Inventory (BSI), Functional Assessment Short Test (FAST), Empathy Quotient (EQ) and Parent-Child Relationship Scale (P-CRS). Results: The evaluations showed that 11 out of 64 patients no longer met the ASD diagnostic criteria. It was found that the ASD group had more psychiatric comorbidities and used more psychopharmacological treatment than the individuals who lost the ASD diagnosis. It was observed that the individuals who lost the ASD diagnosis had higher scores in ASSP scores. In addition, higher scores were found in the ASD group on the FAST and BSI scales administered to parents. Similarly, it was observed that the parents received significantly higher scores in the EQ and P-CRS positive scores applied to the individuals who lost the ASD diagnosis. It was determined that the CARS scores of the individuals who lost the ASD diagnosis during the period when they met the ASD diagnosis were lower than the ASD IX group. In the ASD group, no significant difference was found between the results of the CARS scores applied in 2016 and this study. In addition, it was determined that 45 of the 53 participants diagnosed with ASD had comorbid diagnoses of intellectual disability, and there was no intellectual disability in the individuals who lost the ASD diagnosis. Conclusions: This study has shown that individuals diagnosed with ASD continue to be diagnosed in the long term and have more comorbid psychopathologies than individuals who lose their diagnosis. Additionally, it was found that the functionality level and empathy skills of individuals with ASD in their families were lower. In order to affect positively the clinical course of these cases in the future and their functionality in social, academic, and family relationships, it is necessary to increase the scope and quality of the intervention methods, along with the importance of early diagnosis, to be applied to the individuals. As a result, in addition to comprehensive mental health assessment during the long-term psychiatric follow up of these individuals, evaluating their families and including them in intervention programs may be clinically and socially beneficial. Keywords: autism spectrum disorder; prognosis; loss of autism diagnosis; familial factors
Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder whose symptoms begin in the first years of life, and include inadequacy in establishing and maintaining communication and social skills, insistence on sameness, limited range of interests, and repetitive behaviors, and its effects last throughout life. Many factors observed during the disease are important for the course and prognosis of the disease. Factors associated with positive outcomes include higher cognitive function, presence of joint attention, presence of mild ASD symptoms, tendency to socialize with peers, functional gaming skills, and early diagnosis. Evaluating the course of symptoms of individuals with ASD who have difficulties in many areas, including reaching independent living standards, academic success, social relations, and friendships, and taking appropriate precautions in this process may be beneficial for both themselves and their families. Objective: In this study, we aimed to compare the severity and developmental course of symptoms in patients diagnosed with ASD in our clinic in 2016, while also evaluating the individual and familial factors associated with symptom severity. Method: 64 out of 100 patients diagnosed with ASD in 2016 were reached and psychiatric examinations were performed according to K-SADS and DSM-5. In these cases, the Childhood Autism Rating Scale (CARS), The Clinician-Rated Severity of Autism Spectrum and Social Communication Disorders, Autism Behavior Checklist (ABC), Autism Social Skills Profile (ASSP), and Social Responsiveness Scale (SRS) scales were used. In addition, parents were asked to fill out the Brief Symptom Inventory (BSI), Functional Assessment Short Test (FAST), Empathy Quotient (EQ) and Parent-Child Relationship Scale (P-CRS). Results: The evaluations showed that 11 out of 64 patients no longer met the ASD diagnostic criteria. It was found that the ASD group had more psychiatric comorbidities and used more psychopharmacological treatment than the individuals who lost the ASD diagnosis. It was observed that the individuals who lost the ASD diagnosis had higher scores in ASSP scores. In addition, higher scores were found in the ASD group on the FAST and BSI scales administered to parents. Similarly, it was observed that the parents received significantly higher scores in the EQ and P-CRS positive scores applied to the individuals who lost the ASD diagnosis. It was determined that the CARS scores of the individuals who lost the ASD diagnosis during the period when they met the ASD diagnosis were lower than the ASD IX group. In the ASD group, no significant difference was found between the results of the CARS scores applied in 2016 and this study. In addition, it was determined that 45 of the 53 participants diagnosed with ASD had comorbid diagnoses of intellectual disability, and there was no intellectual disability in the individuals who lost the ASD diagnosis. Conclusions: This study has shown that individuals diagnosed with ASD continue to be diagnosed in the long term and have more comorbid psychopathologies than individuals who lose their diagnosis. Additionally, it was found that the functionality level and empathy skills of individuals with ASD in their families were lower. In order to affect positively the clinical course of these cases in the future and their functionality in social, academic, and family relationships, it is necessary to increase the scope and quality of the intervention methods, along with the importance of early diagnosis, to be applied to the individuals. As a result, in addition to comprehensive mental health assessment during the long-term psychiatric follow up of these individuals, evaluating their families and including them in intervention programs may be clinically and socially beneficial. Keywords: autism spectrum disorder; prognosis; loss of autism diagnosis; familial factors
Açıklama
Anahtar Kelimeler
Psikiyatri, Psychiatry, otizm, prognoz, tanı kaybı, ailesel faktörler, autism spectrum disorder, prognosis, loss of autism diagnosis, familial factors
