Anoreksiya nervoza ve eksojen obezite tanılı 11-18 yaş arası olgularda dikkat eksikliği ve hiperaktivite bozukluğu ek tanısı ve takıntılı spor yapma davranışının incelenmesi
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Tarih
2018
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: AN ve DEHB dürtüsellik alt yapısında gelişip, toplumun özellikle genç nüfusunu etkileyerek günümüzde kendinden sıkça söz ettirerek halk sağlığı sorunu haline geldikleri bilinmektedir. Genç nüfusta yaygınlığı giderek artan obezite ise psikiyatri otörlerince ruhsal bozukluk snıflamasına girmeye aday bir sorun olmasına rağmen, ne yazık ki yapılandırılmış ruh sağlığı tanı ve tedavi kılavuzlarında yerini alamamıştır. Diğer taraftan obezite ve YB'nin birlikte görülmesi, obezitenin aslında yeme bozukluğunun bir sonucu ya da sebebi değil, aynı psikopatolojinin farklı bir görünümü olduğunu ve bu durumun; içinde dürtüselliği de barındıran bir spektrum bozukluğu olabileceğini düşündürtmektedir. AN, DEHB ve obezite tanılı gençlerin hayatlarının bir bölümünde aşırı egzersiz yaptığı, belli dönemlerde bağımlılık boyutuna varan davranışlar gösterdiği gözlenmiştir. Literatür tarandığında görülmüştür ki; bu bozuklukların dürtüsellik zemininde gelişen ortak bir etyopatogenezi paylaştıkları varsayımı ve bu varsayımda egzersiz bağımlılığının bu hastalıklara eşlik edebilecek farklı bir problem olabileceği çıkarımıyla ilgili dünyada ve ülkemizde herhangi bir çalışma yoktur. İnsan sağlığına ve ülke ekonomisine de oldukça zararı olan obezite ve YB'nin aynı hastalığın farklı görüntüsü olması hipotezinin doğrulanması ise tedavide yeni bir ekolü de beraberinde getirecektir. Çalışmamızın amacı AN ve obezite tanılı 11-18 yaş arası olgularda ek DEHB bulguları ve egzersiz bağımlılığını değerlendirmektir. Yöntem: Ege Üniversitesi Tıp Fakültesi Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Anabilim Dalı Ergen Birimi Polikliniği'nde AN tanısı ile takip edilen 11- 18 yaş arası 30 olgu, Ege Üniversitesi Tıp Fakültesi Çocuk Endokrinoloji Bilim Dalı'nda eksojen obezite ile takip edilen 11-18 yaş 30 olgu ve çalışma grubuna benzer sosyodemografik özelliklere sahip 30 sağlıklı olgu çalışmamızın örneklemini oluşturmaktadır. Öncelikle tüm olgular DSM-V tanı kriterleri ve KSADS uygulaması yapılarak iki ayrı araştrımacı tarafından değerlendirildi. Değerlendirme sonucu eşlik eden eşik altı psikiyatrik semptomların saptanması durumunda hastaların işlevselliği ve semptomların şiddeti GAS kullanılarak değerlendirildi. Olguların uygunsuz yeme tutum ve davranışları YTT, depresyon belirtileri 15 yaş altı gençler için CDI, 15 yaş ve üzeri için BDÖ, anksiyete belirtileri STAI-Durumluk ve Süreklik Kaygı Ölçekleri, duygu düzenlemedeki güçlükleri DDÖ, antisosyal özellikte davranış sorunları ve sosyal bilişsel özellikleri ICU, egzersiz bağımlılığı semptom ve şiddetlerini EBÖ-21 ile değerlendirildi. Olguların DEHB belirtileri DEHB-Aile ölçeği, OSB ilişkili özellikleri ise ailelerin doldurğu ASSQ ile değerlendirilmiştir. Hasta gruplarında, hastalığın şiddetini değerlendirmeye yönelik olarak, CGI-S uygulandı. Elde edilen veriler SPSS istatistik programı ile analiz edildi. Bulgular: Obezite grubunun DEHB belirti düzeyi AN olguları ve sağlıklı kontrollerden anlamlı ölçüde yüksektir. AN olgularının DEHB belirtileri düzeyi de sağlıklı kontrollerden yüksektir ancak bu farklılık istatistiksel olarak anlamlı düzeyde değildir. AN olgularının egzersiz bağımlılığı riski obezite ve sağlıklı kontrollerden anlamlı düzeyde yüksektir. AN olgularının emosyon düzenleme becerileri obezite ve sağlıklı kontrollere göre anlamlı ölçüde kötüdür. AN ve obezite olguları sağlıklı kontrollere göre anlamlı ölçüde fazla miktarda OSB ile ilişkili özellik taşımaktadır. AN ve obezite olgularının depresyon puanları sağlıklı kontrollerden yüksektir. AN olgularının STAI anksiyete ölçeği skorları obezite olgularından yüksek, obezite olgularının anksiyete skorları ise sağlıklı kontrollerden yüksektir. Bu bulgulara ek olarak egzersiz bağımlılık düzeyinin artması ile anksiyete düzeyinin ve emosyonel düzenlemede sorunların artması arasında aynı yönde bir ilişki vardır. Ancak bu ilişkide hangi faktörün neden, hangisinin sonuç olduğu bilinmemektedir. Sonuç: Bu çalışmada AN ve obezite olgularının tümünde DEHB bulgularının sağlıklı popülasyondan daha fazla görüldüğü saptanmıştır. Hem AN hem de obezite gruplarının sosyal becerileri ve emosyonel becerilerinde bozukluklar olduğu, OSB özellikleriyle örtüşen yanları olduğu görülmüştür. Günümüzde henüz bir ruhsal hastalık olarak tanımlanmayan obezitenin, bir yeme bozukluğu olan AN ile örtüşen birçok psikopatolojik özelliği olduğu saptanmıştır. Egzersiz bağımlılığının AN'de ikincil olarak ortaya çıkma riskinin yüksek olduğu ve bu durumun önemli bir morbidite sebebi olduğu görülmüştür. Çalışmamızın bulguları, söz konusu hastalıkların tanı ve tedavisinde etkili ve kalıcı bir yaklaşım için bu hastalıklarda DEHB belirtilerinin, sosyal bilişsel bozuklukların ve egzersiz bağımlılığının tanınmasının önemini vurgulamaktadır.
Introduction: It is known that Anorexia Nervosa (AN) and Attention Deficit Hyperactivity Disorder (ADHD) which develop in the substructure of impulsivity, have become a serious public health issue by affecting young population. Although obesity whose prevalence increasing in young population is regarded as a candidate problem to be involved in the psychiatric disorder classification by psychiatric professionals, it has not come in on structured mental health diagnosis and treatment guidelines yet, unfortunately. On the flip side, concomitance of obesity and other eating disorders together cause us to think that obesity is neither an outcome nor a reason of eating disorders, conversely a different clinical manifestation of the same psychopathology, which may be a spectrum disorder also including impulsivity. It was observed that adolescents diagnosed with AN, ADHD or Obesity, take exercise excessively and show their exercise manners like almost at the level of dependence, in some periods of their life. When the literature is reviewed, it is seen that there is no study both all around the world and Turkey concerning the assumption of these disorders to have the common etiopathogenesis developed in the basis of impulsivity and the inference of exercise addiction to be a distinctive disorder that may accompany to these disorders. Obesity and eating disorders damage both human health and the country’s economy; based on this point, correction of the hypothesis of obesity and eating disorders to be diverse manifestations of the unique and same disorder, may lead to a new approach on treatment. The aim of our study is to evaluate the additional ADHD symptoms and exercise addiction in the cases with the age range of 11 to 18 diagnosed with AN and obesity. Method: Sample of our study was comprised of 30 subjects aged between 11 and 18 and followed up with the diagnosis of Anorexia Nervosa in the Department of Child and Adolescent Psychiatry, Ege University, 30 subjects between 11 and 18 and followed up with the diagnosis of Exogenous Obesity in the Department of Pediatric Endocrinology, Ege University and 30 healthy controls having similar sociodemographic features like case groups have. First, all the subjects were evaluated according to DSM-5 Diagnostic Criteria and interviewed with semi-structured interview called Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) by two researchers separately. After evaluation, patients’ functioning and severity of the symptoms were assessed using Global Assessment Scale (GAS) when detected accompanying subthreshold psychiatric symptoms. Of the subjects, inappropriate eating attitudes and behaviors were measured with Eating Attitudes Test-40 (EAT-40), while depression symptoms with Children’s Depression Inventory (CDI) for those under 15-year-age, Beck Depression Inventory (BDI) for those 15-year-age and above, anxiety symptoms with State-Trait Anxiety Inventory (STAI), difficulties in emotion regulation with Difficulties in Emotion Regulation Scale (DERS), behavioral problems having antisocial characteristics and social cognitional features with Inventory of Callous-Unemotional Traits (ICU) and exercise addiction symptoms and their severity with Exercise Dependence Scale (EDS-21). ADHD symptoms of the cases were assessed by Turgay’s ADHD Scale (ADHD DSM-4) by parents and the characteristics of Autism Spectrum Disorders (ASD) were detected using Autism Spectrum Screening Questionnaire (ASSQ) filled out by parents. Patient groups completed Clinic Global Impression Scale-Severity (CGI-S) to self-report the symptom severity of disorder they had. Results: We detected that ADHD symptom severity in Obesity group was significantly higher than AN group and healthy controls. Even so, ADHD symptom intensity was higher in AN group than controls, but this severity difference was not statistically significant. It was observed that exercise dependence risk in AN subjects was significantly higher than obese teens and healthy controls. We also found that Emotion regulation abilities in AN cases were significantly worse than in obese cases and controls. Anorexia and obese cases had significantly much more characteristics associated with ASD compared to healthy controls. AN and obese participants’ depression scores were higher than controls. While AN adolescents’ STAI anxiety scale scores were higher than obese group’s scores; obese cases had greater anxiety scores on STAI than healthy controls had. In addition to these findings, it was determined that there was a correlation in the same direction between the increase of exercise addiction level and the increase of both anxiety level and on having trouble in emotional regulation. However, it is still unclear which factor is reason and which is result. Conclusion: We detected that ADHD symptoms were seen in higher rates in all of adolescents with AN and obesity than in healthy young population. It was ascertained that both AN and obese participants had impairment in social and emotional skills, and these groups had some overlapping characteristics with ASD. It was estimated that “obesity” which is not defined as a mental disorder yet, has numerous overlapping psychopathological features with “AN” as defined an eating disorder. It was seen that, the occurrence risk of exercise addiction as being secondarily in AN is quite high and this condition is supposed to be a crucial morbidity factor. The findings of our study highlighted the importance of recognition of ADHD symptoms, social cognitional impairments and exercise addiction in AN and obesity for more effective and permanent approach about diagnosing and treatment modalities.
Introduction: It is known that Anorexia Nervosa (AN) and Attention Deficit Hyperactivity Disorder (ADHD) which develop in the substructure of impulsivity, have become a serious public health issue by affecting young population. Although obesity whose prevalence increasing in young population is regarded as a candidate problem to be involved in the psychiatric disorder classification by psychiatric professionals, it has not come in on structured mental health diagnosis and treatment guidelines yet, unfortunately. On the flip side, concomitance of obesity and other eating disorders together cause us to think that obesity is neither an outcome nor a reason of eating disorders, conversely a different clinical manifestation of the same psychopathology, which may be a spectrum disorder also including impulsivity. It was observed that adolescents diagnosed with AN, ADHD or Obesity, take exercise excessively and show their exercise manners like almost at the level of dependence, in some periods of their life. When the literature is reviewed, it is seen that there is no study both all around the world and Turkey concerning the assumption of these disorders to have the common etiopathogenesis developed in the basis of impulsivity and the inference of exercise addiction to be a distinctive disorder that may accompany to these disorders. Obesity and eating disorders damage both human health and the country’s economy; based on this point, correction of the hypothesis of obesity and eating disorders to be diverse manifestations of the unique and same disorder, may lead to a new approach on treatment. The aim of our study is to evaluate the additional ADHD symptoms and exercise addiction in the cases with the age range of 11 to 18 diagnosed with AN and obesity. Method: Sample of our study was comprised of 30 subjects aged between 11 and 18 and followed up with the diagnosis of Anorexia Nervosa in the Department of Child and Adolescent Psychiatry, Ege University, 30 subjects between 11 and 18 and followed up with the diagnosis of Exogenous Obesity in the Department of Pediatric Endocrinology, Ege University and 30 healthy controls having similar sociodemographic features like case groups have. First, all the subjects were evaluated according to DSM-5 Diagnostic Criteria and interviewed with semi-structured interview called Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) by two researchers separately. After evaluation, patients’ functioning and severity of the symptoms were assessed using Global Assessment Scale (GAS) when detected accompanying subthreshold psychiatric symptoms. Of the subjects, inappropriate eating attitudes and behaviors were measured with Eating Attitudes Test-40 (EAT-40), while depression symptoms with Children’s Depression Inventory (CDI) for those under 15-year-age, Beck Depression Inventory (BDI) for those 15-year-age and above, anxiety symptoms with State-Trait Anxiety Inventory (STAI), difficulties in emotion regulation with Difficulties in Emotion Regulation Scale (DERS), behavioral problems having antisocial characteristics and social cognitional features with Inventory of Callous-Unemotional Traits (ICU) and exercise addiction symptoms and their severity with Exercise Dependence Scale (EDS-21). ADHD symptoms of the cases were assessed by Turgay’s ADHD Scale (ADHD DSM-4) by parents and the characteristics of Autism Spectrum Disorders (ASD) were detected using Autism Spectrum Screening Questionnaire (ASSQ) filled out by parents. Patient groups completed Clinic Global Impression Scale-Severity (CGI-S) to self-report the symptom severity of disorder they had. Results: We detected that ADHD symptom severity in Obesity group was significantly higher than AN group and healthy controls. Even so, ADHD symptom intensity was higher in AN group than controls, but this severity difference was not statistically significant. It was observed that exercise dependence risk in AN subjects was significantly higher than obese teens and healthy controls. We also found that Emotion regulation abilities in AN cases were significantly worse than in obese cases and controls. Anorexia and obese cases had significantly much more characteristics associated with ASD compared to healthy controls. AN and obese participants’ depression scores were higher than controls. While AN adolescents’ STAI anxiety scale scores were higher than obese group’s scores; obese cases had greater anxiety scores on STAI than healthy controls had. In addition to these findings, it was determined that there was a correlation in the same direction between the increase of exercise addiction level and the increase of both anxiety level and on having trouble in emotional regulation. However, it is still unclear which factor is reason and which is result. Conclusion: We detected that ADHD symptoms were seen in higher rates in all of adolescents with AN and obesity than in healthy young population. It was ascertained that both AN and obese participants had impairment in social and emotional skills, and these groups had some overlapping characteristics with ASD. It was estimated that “obesity” which is not defined as a mental disorder yet, has numerous overlapping psychopathological features with “AN” as defined an eating disorder. It was seen that, the occurrence risk of exercise addiction as being secondarily in AN is quite high and this condition is supposed to be a crucial morbidity factor. The findings of our study highlighted the importance of recognition of ADHD symptoms, social cognitional impairments and exercise addiction in AN and obesity for more effective and permanent approach about diagnosing and treatment modalities.
Açıklama
Anahtar Kelimeler
Ergenlerde Yeme Bozuklukları, Egzersiz Bağımlılığı, Obezite, Dikkat Eksikliği Ve Hiperaktivite Bozuklukları, Komorbidite, Eating Disorders İn Adolescents, Exercise Addiction, Obesity, Attention Deficit Hyperactivity Disorder, Comorbidity
