Genel psikiyatri polikliniği ve bir aile danışmanlık merkezine ilk kez başvuran olgularda erişkin dikkat eksikliği hiperaktivite bozukluğu ve erişkin dikkat eksikliği hiperaktivite bozukluğu'na eşlik eden I. eksen psikiyatrik bozukluk yaygınlığının araştırılması
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Dosyalar
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Araştırmamızın birincil amacı bir üniversite hastanesi erişkin genel psikiyatri polikliniğine ilk kez başvuran ardışık olgular ile bir aile danışmanlık merkezine ilk kez başvuran ardışık olgulardaki erişkin dikkat eksikliği hiperaktivite bozukluğu (DEHB) yaygınlığını araştırmaktır. Araştırmamızın ikincil amacı ise erişkin DEHB'li olguların başvuru nedenlerini ve DEHB'ye eşlik eden I.eksen psikiyatrik bozukluk yaygınlığını belirlemektir. YÖNTEM: Araştırmamız Ege Üniversitesi Tıp Fakültesi (EÜTF) Erişkin Genel Psikiyatri Polikliniği ile Aile ve Sosyal Politikalar Bakanlığı'na bağlı Psikoaktif Aile Danışmanlık Merkezi'nde yürütülmüş olan kesitsel bir epidemiyolojik çalışmadır. Araştırmayla ilgili bilgi verilerek araştırmaya katılmayı kabul ettiklerini gösterir yazılı onayları alınan ve klinik değerlendirme öncesinde dışlama ölçütlerini karşılamayan olgulardan araştırmada kullanılan olgu rapor formunu, Erişkin Dikkat Eksikliği Hiperaktivite Bozukluğu Kendi Bildirim Ölçeği (ASRS)'yi, Turgay'ın DSM-IV'ye Dayalı Erişkin DEB/DEHB Tanı ve Değerlendirme Envanteri'ni ve Wender Utah Derecelendirme Ölçeği (WUDÖ)'yü başvurdukları merkez şartlarında doldurmaları istenmiştir. Tarama ölçeklerinin herhangi birinden kesme puanının üzerinde skor alanlar (ASRS'nin A bölümündeki taralı alanlarda 4 ya da daha fazla maddeyi işaretleyenler; Turgay'ın DSM-IV'ye Dayalı Erişkin DEB/DEHB Tanı ve Değerlendirme Envanteri'nde 1. veya 2. bölümdeki dokuzar sorudan en az beş tanesine 2 veya 3 puan verenler) genel psikiyatri polikliniğinde klinik görüşmeye alınmıştır. Aile danışmanlık merkezine başvuran olgular arasında tarama ölçeklerinin herhangi birinden kesme puanının üzerinde skor alanlar ise telefonla aranarak EÜTF'ye klinik görüşme için davet edilmiştir. Bu çalışmada duyarlılığı arttırmak için iki farklı tarama testi kullanılmıştır. Tarama testlerinin en az birinden geçerek klinik görüşmeye alınan olgulara Erişkinlerde DEHB için Tanısal Görüşme (DIVA 2.0) uygulanmıştır. Erişkin DEHB için tanısal değerlendirme yapılırken DSM-5 kriterleri dikkate alınmıştır. Mümkün olduğu durumlarda kişilerin 1.dereceden yakınları ile yüz yüze ya da telefonla görüşülerek çocukluk dönemleri ile ilgili bilgi alınmaya ve tanı doğrulanmaya çalışılmıştır. DIVA 2.0 ile değerlendirilerek erişkin DEHB tanısı konan olgulara DSM-IV Eksen I Bozuklukları için Yapılandırılmış Klinik Görüşme (SCID-I) uygulanmıştır. Çocukluk çağı DEHB belirtilerini sorgulamaya yönelik olarak kullanılan WUDÖ'de kesme puanı 36 ve üzeri olarak belirlenmiştir. Bu görüşmeler yaklaşık 2 saat süren tek oturumda yapılmıştır. BULGULAR: DSM-5 kriterlerine göre yapılan değerlendirmede 210 olgudan oluşan genel psikiyatri polikliniği örneklemindeki erişkin DEHB yaygınlığı %14,3 (n=30); 133 olgudan oluşan aile danışmanlık merkezi örneklemindeki erişkin DEHB yaygınlığı ise %9,8 (n=13) olarak hesaplanmıştır. SCID-I'e göre genel psikiyatri polikliniği erişkin DEHB olgularına en sık eşlik eden tanılar sırasıyla depresif bozukluk (%40), özgül fobi (%26,7), alkol kötüye kullanımı (%16,7), distimik bozukluk (%16,7) ve obsesif-kompulsif bozukluk (%13,4) şeklinde; aile danışmanlık merkezi erişkin DEHB olgularına en sık eşlik eden tanılar ise depresif bozukluk (%46,1) ve alkol kötüye kullanımı (%23,1) şeklinde sıralanmıştır. Genel poliklinik DEHB olgularına en az bir psikiyatrik bozukluk eşlik etme oranı %80, birden çok psikiyatrik bozukluk eşlik etme oranı %46,7'dir. Aile danışmanlık merkezi DEHB olgularına en az bir psikiyatrik bozukluk eşlik etme oranı %84,6, birden çok psikiyatrik bozukluk eşlik etme oranı ise %30,8'dir. Genel poliklinik DEHB olgularının ASRS (z=-2,345; p=0,019), Turgay'ın DSM-IV'ye Dayalı Erişkin DEB/DEHB Tanı ve Değerlendirme Envanteri 3. Bölüm (DEHB ile ilgili özellikler ve sorunlar bölümü)(z=-2,461; p=0,014) ölçek puanları aile danışmanlık merkezi DEHB olgularından anlamlı düzeyde yüksektir; WUDÖ ölçek puanları da genel poliklinik DEHB olgularında yüksek bulunmuş ancak aradaki fark istatistiksel anlamlılık kazanmamıştır (z=-1,045; p=0,296). Genel poliklinik DEHB olgularında DEHB'li olmayanlara göre disiplin cezası almış olma (χ²=9,210; p=0,011), sık iş değiştirme (χ²=11,989; p=0,002), polis ile başının derde girmiş olması (χ²=8,68; p=0,009), iş/ev kazası geçirmiş olma (χ²=5,501; p=0,028) oranları; aile danışmanlık merkezi DEHB olgularında ise DEHB'li olmayanlara göre disiplin cezası almış olma (χ²=18,423; p=0,001), polis ile başının derde girmiş olması (χ²=11,997; p=0,005), adli sorun yaşamış olma (χ²=5,466; p=0,035) oranları yüksek bulunmuştur. Genel poliklinik (χ²=1,776; p=0,180) ve aile danışmanlık merkezi (χ²=3,263; p=0,090) DEHB olgularında DEHB'li olmayanlara göre intihar girişiminde bulunmuş olma oranları da yüksek bulunmuş ancak aradaki fark istatistiksel anlamlılık kazanmamıştır. Çocukluk döneminde DEHB tanısı almış olan erişkin DEHB tanılı olguların oranı genel poliklinikte %16,7; aile danışmanlık merkezinde ise %30,8'dir. Genel poliklinik DEHB olgularının yalnızca %30'u, aile danışmanlık merkezi DEHB olgularının ise yalnızca %15,4'ü kendisinde DEHB olduğundan kuşkulanarak başvuruda bulunmuştur. Başvuru yakınmalarına baktığımızda aile danışmanlık merkezi DEHB olgularından evlilik/ilişki sorunları (%84,6'ya karşı %49,5) (χ²=5,680;p=0,037), kendi içinde yaşadığı sorunlar (%53,8'e karşı %14,7) (χ²=11,166; p=0,003), eğitim hayatındaki sorunlar (%46,2'ye karşı %9,5) (χ²=12,864; p=0,03) nedeniyle başvuranların oranının DEHB'li olmayanlardan istatistiksel olarak anlamlı düzeyde yüksek olduğu; iş hayatındaki sorunlar (%30,8'e karşı %10,5) (χ²=4,153; p=0,064) nedeniyle başvuranların da istatistiksel anlamlılık kazanmasa da yine DEHB'li olmayanlardan yüksek olduğu görülmüştür. Genel poliklinikte DEHB tanısı alan ve almayan olgular arasında başvuru nedenleri açısından istatistiksel olarak anlamlı fark gözlenmemiştir. Aile danışmanlık merkezine başvurarak DEHB tarama testlerini geçen olguların %54'ü hastanede klinik görüşme yapılması için olan davete olumlu yanıt vermemiştir. SONUÇ: Araştırmamızda genel psikiyatri polikliniği ve aile danışmanlık merkezine başvuran olgulardaki erişkin DEHB yaygınlığı genel toplum örneklemi için bildirilenden yüksek bulunmuştur. Her iki merkezde de DEHB olgularının tamamına yakınında eşlik eden en az bir psikiyatrik bozukluğa rastlanmıştır. Genel psikiyatri polikliniğine başvuran DEHB olgularının daha ağır seyrettiği ve birden çok psikiyatrik bozukluk eşlik etme oranının istatistiksel anlamlılığa ulaşmasa da aile danışmanlık merkezi DEHB olgularından yüksek olduğu görülmüştür. Evlilik/ilişki sorunları, kendi içinde sorunlar, eğitim hayatında sorunlar, iş hayatında sorunlar yaşayan DEHB olguları ilaç dışı tedavi yöntemlerin uygulanmasını bekledikleri aile danışmanlık merkezine başvurmuştur. Aile danışmanlık merkezine başvuran olgular arasında DEHB olasılığı yüksek olan bir grubun psikiyatri polikliniğine yönlendirilmeleri konusunda güçlükler yaşanmıştır. DEHB tanısı psikiyatri kliniklerinde eş tanı oranlarının yüksek olması nedeniyle, aile danışmanlık merkezlerinde ise diğer yaşamsal sorunların ön plana çıkmış olması nedeniyle atlanıyor görünmektedir. Bu çalışmadan elde edilen verilerin DEHB'nin yaygınlığının, erişkinlerdeki klinik görünümünün, olguların psikiyatri klinikleri ve aile danışmanlık merkezlerine başvuru nedenlerinin daha iyi anlaşılmasına katkıda bulunması umulmaktadır. Bu çalışma farmakoterapi dışı tedavi yöntemlerinin uygulanmasını bekleyen bir grupta erişkin DEHB prevalansını gösteren, DEHB'lilerin klinik görünümünü ve başvuru nedenlerini ortaya koyan ilk çalışmadır; ancak kuşkusuz bu alandaki bilgi birikimi ve deneyimin arttırılması için ruh sağlığı alanında hizmet veren veren kurumlarda daha geniş ölçekli yeni araştırmaların yapılmasına ihtiyaç vardır.
OBJECTIVE: The primary objective of this study was to identify the prevalence of adult attention deficit hyperactivity disorder (ADHD) among first time admitted consecutive cases of a university hospital general psychiatry outpatient clinic and a family counselling center. Second aim of the study was to define the causes of admissions to this centers and prevalence of comorbid axis-I disorders in adult ADHD cases. METHOD: This study was a cross-sectional epidemiological study conducted in general psychiatry outpatient clinic of Ege University Faculty of Medicine and Psikoaktif Family Counselling Center linked to Ministry of Family and Social Policies. After having provided written informed consent of cases which does not meet any exclusion criteria before clinical assessment were given to Adult ADHD Self-Report Scale (ASRS), Turgay's Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale, Wender Utah Rating Scale (WURS) and the case report form used in this study. Positively screened cases according to ASRS (at least 4 out of 6 responses exceeding threshold in Part A) or Turgay's Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale (at least 5 out of 9 responses exceeding threshold in Part 1 or 2) were clinicially assessed in general psychiatry outpatient clinic. Positively screened cases of family counselling center according to at least one of these screening tests were invited to Ege University Faculty of Medicine via telephone for clinical assessment. In this study two different screening tests were used to increase sensitivity. Diagnostic Interview for ADHD in Adults (DIVA 2.0) were applied to positively screened cases for ADHD diagnosis. DSM-5 criteria were taken into consideration in ADHD diagnostic interviews. Whenever possible the DIVA 2.0 was completed with the patients first degree relatives to enable retrospective and collateral information; information received via telephone was also accepted. Patients who were diagnosed with adult ADHD via DIVA 2.0 were evaluated by Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). WURS was used to evaluate childhood ADHD symptoms and cut-off score was 36 or higher in this study. These interviews were completed approximately in 2 hours in a single session. RESULTS: The prevalence of adult ADHD according to DSM-5 criteria in general psychiatry outpatient clinic including 210 individuals was 14,3% (n=30). The prevalence of adult ADHD in family counselling center including 133 individuals was 9,8% (n=13). According to SCID-I the most common type of comorbid psychiatric disorders among ADHD diagnosed patients of general psychiatry outpatient clinic were depressive disorder (40%), specific phobia (26,7%), alcohol abuse (16,7%), dysthymic disorder (16,7%) and obsessive-compulsive disorder (13,4%), respectively. The most common type of comorbid psychiatric disorders among ADHD diagnosed patients of family counselling center were depressive disorder (46,1%) and alcohol abuse (23,1%). 80% of ADHD patients in general psychiatry outpatient clinic were diagnosed with at least one additonal psychiatric disorder and 46,7% were diagnosed with more than one additonal psychiatric disorder; it was 84,6% and 30,8% for family counselling center, respectively. Patients with ADHD in general psychiatry outpatient clinic had higher ASRS (z=-2,345; p=0,019) and Turgay's Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale Part-3 (Part of problems and features of ADHD) (z=-2,461; p=0,014) scores than patients with ADHD in family counselling center; WURS scores were also higher but it was not statistically significant (z=-1,045; p=0,296). Patients with ADHD in general psychiatry outpatient clinic reported more disciplinary penalty at school (χ²=9,210; p=0,011), frequent job change (χ²=11,989; p=0,002), problem with police unit (χ²=8,68; p=0,009), occupational/home accident (χ²=5,501; p=0,028) than patients without ADHD. Patients with ADHD in family counselling center reported more disciplinary penalty at school (χ²=18,423; p=0,001), problem with police unit (χ²=11,997; p=0,005) and judicial problem (χ²=5,466; p=0,035) than patients without ADHD. Patients with ADHD in general psychiatry outpatient clinic (χ²=1,776; p=0,180) and family counselling center (χ²=3,263; p=0,090) reported more suicide attempts than patients without ADHD; but it was not statistically significant. 16,7% of patients with adult ADHD in general psychiatry outpatient clinic and 30,8% of patients with adult ADHD in family counselling center have been diagnosed with ADHD in childhood. Only 30% of patients with ADHD in general psychiatry outpatient clinic and only 15,4% of patients with ADHD in family counselling center were admitted suspecting they had an ADHD. When we look at their causes of admission, it is seen that patients with ADHD in family counselling center reported more marriage/relationship problems (84,6% vs 49,5%) (χ²=5,680; p=0,037), personal problems (53,8% vs 14,7%) (χ²=11,166; p=0,003) and educational problems (46,2% vs 9,5%) (χ²=12,864; p=0,003) than patients without ADHD; also reported more occupational problems (30,8% vs 10,5%) (χ²=4,153; p=0,064) but it was not statistically significant. In general psychiatry outpatient clinic there were statistically no significant difference between ADHD and non-ADHD patients in terms of causes of admission. 54% of positively screened family counselling center cases of ADHD did not accept the invitation to hospital which was done with the aim of further clinical assessment. CONCLUSION: In this study we found the prevalence of adult ADHD in general psychiatry outpatient clinic and family counselling center much higher than estimates for general adult population. Almost all adult ADHD patients of both centers had at least one additional psychiatric disorder. It is seen that it was more severe form of ADHD in general psychiatry outpatient clinic; even though it was not statistically significant, the prevalence of having more than one additional psychiatric disorder in ADHD patients of general psychiatry outpatient clinic was higher than family counselling center ADHD patients. Adult ADHD patients which have marriage/relationship, personal, educational and occupational problems preferred admission to a family counselling center expecting a treatment method other than pharmacotherapy. During the study we met with some difficulties in referral of probably ADHD diagnosed cases of family counselling center to the hospital for a clinical assessment. It seems that adult ADHD diagnosis is missing in general psychiatry outpatient clinics because of prevalent comorbid psychiatric disorders and missing in family counselling centers because of other prominent everyday life problems. It is hoped that data from this study contribute to a better understanding of the prevalence and clinical presentations of adult ADHD patients and their causes of admissions to general psychiatry outpatient clinic and family counselling centers. To our knowledge, this is the first study to evaluate the prevalence of adult ADHD, their clinical presentation and causes of admissions in a group expecting treatment method other than pharmacotherapy. However, further studies in other mental health centers with a larger sample sizes are needed to improve the knowledge and experience in this field.
OBJECTIVE: The primary objective of this study was to identify the prevalence of adult attention deficit hyperactivity disorder (ADHD) among first time admitted consecutive cases of a university hospital general psychiatry outpatient clinic and a family counselling center. Second aim of the study was to define the causes of admissions to this centers and prevalence of comorbid axis-I disorders in adult ADHD cases. METHOD: This study was a cross-sectional epidemiological study conducted in general psychiatry outpatient clinic of Ege University Faculty of Medicine and Psikoaktif Family Counselling Center linked to Ministry of Family and Social Policies. After having provided written informed consent of cases which does not meet any exclusion criteria before clinical assessment were given to Adult ADHD Self-Report Scale (ASRS), Turgay's Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale, Wender Utah Rating Scale (WURS) and the case report form used in this study. Positively screened cases according to ASRS (at least 4 out of 6 responses exceeding threshold in Part A) or Turgay's Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale (at least 5 out of 9 responses exceeding threshold in Part 1 or 2) were clinicially assessed in general psychiatry outpatient clinic. Positively screened cases of family counselling center according to at least one of these screening tests were invited to Ege University Faculty of Medicine via telephone for clinical assessment. In this study two different screening tests were used to increase sensitivity. Diagnostic Interview for ADHD in Adults (DIVA 2.0) were applied to positively screened cases for ADHD diagnosis. DSM-5 criteria were taken into consideration in ADHD diagnostic interviews. Whenever possible the DIVA 2.0 was completed with the patients first degree relatives to enable retrospective and collateral information; information received via telephone was also accepted. Patients who were diagnosed with adult ADHD via DIVA 2.0 were evaluated by Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). WURS was used to evaluate childhood ADHD symptoms and cut-off score was 36 or higher in this study. These interviews were completed approximately in 2 hours in a single session. RESULTS: The prevalence of adult ADHD according to DSM-5 criteria in general psychiatry outpatient clinic including 210 individuals was 14,3% (n=30). The prevalence of adult ADHD in family counselling center including 133 individuals was 9,8% (n=13). According to SCID-I the most common type of comorbid psychiatric disorders among ADHD diagnosed patients of general psychiatry outpatient clinic were depressive disorder (40%), specific phobia (26,7%), alcohol abuse (16,7%), dysthymic disorder (16,7%) and obsessive-compulsive disorder (13,4%), respectively. The most common type of comorbid psychiatric disorders among ADHD diagnosed patients of family counselling center were depressive disorder (46,1%) and alcohol abuse (23,1%). 80% of ADHD patients in general psychiatry outpatient clinic were diagnosed with at least one additonal psychiatric disorder and 46,7% were diagnosed with more than one additonal psychiatric disorder; it was 84,6% and 30,8% for family counselling center, respectively. Patients with ADHD in general psychiatry outpatient clinic had higher ASRS (z=-2,345; p=0,019) and Turgay's Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale Part-3 (Part of problems and features of ADHD) (z=-2,461; p=0,014) scores than patients with ADHD in family counselling center; WURS scores were also higher but it was not statistically significant (z=-1,045; p=0,296). Patients with ADHD in general psychiatry outpatient clinic reported more disciplinary penalty at school (χ²=9,210; p=0,011), frequent job change (χ²=11,989; p=0,002), problem with police unit (χ²=8,68; p=0,009), occupational/home accident (χ²=5,501; p=0,028) than patients without ADHD. Patients with ADHD in family counselling center reported more disciplinary penalty at school (χ²=18,423; p=0,001), problem with police unit (χ²=11,997; p=0,005) and judicial problem (χ²=5,466; p=0,035) than patients without ADHD. Patients with ADHD in general psychiatry outpatient clinic (χ²=1,776; p=0,180) and family counselling center (χ²=3,263; p=0,090) reported more suicide attempts than patients without ADHD; but it was not statistically significant. 16,7% of patients with adult ADHD in general psychiatry outpatient clinic and 30,8% of patients with adult ADHD in family counselling center have been diagnosed with ADHD in childhood. Only 30% of patients with ADHD in general psychiatry outpatient clinic and only 15,4% of patients with ADHD in family counselling center were admitted suspecting they had an ADHD. When we look at their causes of admission, it is seen that patients with ADHD in family counselling center reported more marriage/relationship problems (84,6% vs 49,5%) (χ²=5,680; p=0,037), personal problems (53,8% vs 14,7%) (χ²=11,166; p=0,003) and educational problems (46,2% vs 9,5%) (χ²=12,864; p=0,003) than patients without ADHD; also reported more occupational problems (30,8% vs 10,5%) (χ²=4,153; p=0,064) but it was not statistically significant. In general psychiatry outpatient clinic there were statistically no significant difference between ADHD and non-ADHD patients in terms of causes of admission. 54% of positively screened family counselling center cases of ADHD did not accept the invitation to hospital which was done with the aim of further clinical assessment. CONCLUSION: In this study we found the prevalence of adult ADHD in general psychiatry outpatient clinic and family counselling center much higher than estimates for general adult population. Almost all adult ADHD patients of both centers had at least one additional psychiatric disorder. It is seen that it was more severe form of ADHD in general psychiatry outpatient clinic; even though it was not statistically significant, the prevalence of having more than one additional psychiatric disorder in ADHD patients of general psychiatry outpatient clinic was higher than family counselling center ADHD patients. Adult ADHD patients which have marriage/relationship, personal, educational and occupational problems preferred admission to a family counselling center expecting a treatment method other than pharmacotherapy. During the study we met with some difficulties in referral of probably ADHD diagnosed cases of family counselling center to the hospital for a clinical assessment. It seems that adult ADHD diagnosis is missing in general psychiatry outpatient clinics because of prevalent comorbid psychiatric disorders and missing in family counselling centers because of other prominent everyday life problems. It is hoped that data from this study contribute to a better understanding of the prevalence and clinical presentations of adult ADHD patients and their causes of admissions to general psychiatry outpatient clinic and family counselling centers. To our knowledge, this is the first study to evaluate the prevalence of adult ADHD, their clinical presentation and causes of admissions in a group expecting treatment method other than pharmacotherapy. However, further studies in other mental health centers with a larger sample sizes are needed to improve the knowledge and experience in this field.
Açıklama
Anahtar Kelimeler
Aile Danışmanlık Merkezi, Erişkin Dikkat Eksikliği Hiperaktivite Bozukluğu, Eş Tanı, Psikiyatri Polikliniği, Yaygınlık, Adult Attention Deficit Hyperactivity Disorder, Comorbidity, Family Counselling Center, Prevalence, Psychiatry Outpatient Clinic