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Yıl:2013; Cilt: 26; Sayı: 1>> Özet
TAM METİN
Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi; 2013;26(1):12-21
Gerilim ve migren tipi baş ağrılarına eşlik eden islevsel olmayan bilişsel içerikler ve tutumlar
KF Yavuz, N Yavuz, S Ulusoy, İ Alnıak, HNG Güneş
Bakırköy Ruh ve Sinir Hastalıkları Hastanesi,İstanbul
Amaç: Bu araştırmada, birincil baş ağrılarına eşlik edebileceği varsayılan ve anksiyete, depresyon gibi psikiyatrik bozuklukların psikopatolojisinde yer aldığı saptanmış olan bazı işlevsel olmayan bilişsel içerik, süreç ve tutumların varlığı incelenmiştir. Yöntem: Araştırmaya, ülkemizdeki bir eğitim ve araştırma hastanesinin nöroloji polikliniğine başvuran ve çalışmamıza katılmayı kabul eden, IHS (International Headache Society/Uluslararası Başağrısı Birliği) ölçütlerine göre migren tanısı konmuş 33, kronik gerilim tipi baş ağrısı tanısı konmuş 34 hasta ve baş ağrısı yakınması bildirmeyen 33 sağlıklı gönüllü alınmıştır. Katılımcılara sosyodemografik form ile birlikte, bilişsel içerik ve tutumların tespiti amacıyla Otomatik Düşünceler Ölçeği (ODÖ), Beyaz Ayı Supresyon Envanteri (BASE), Ağrıyı Felaketleştirme Ölçeği (AFÖ) uygulanmıştır. Bulgular: Kontrol grubuna göre, gerilim tipi baş ağrısı grubunun ODÖ toplam puanlarında ve ODÖ’ye ait ‘kendine yönelik olumsuz duygu düşünceler’, ‘kişisel uyumsuzluk ve değişme istekleri’ ve ‘ümitsizlik’ alt-ölçekleri puanlarında anlamlı biçimde yükseklik olduğu tespit edilmiştir. BASE toplam puan ortalamalarında ise bu üç grup arasında anlamlı fark saptanmamıştır. AFÖ ve alt-ölçekleri değerlendirildiğinde, migren ve gerilim tipi baş ağrısı grubunun “ruminasyon”, “büyütme”, “çaresizlik” alt-ölçek puanlarının tümünde ve AFÖ toplam puanlarında, kontrol grubuna göre anlamlı olarak yükseklik sergilediği tespit edilmiştir. Sonuç: Migren ve gerilim tipi baş ağrısı gruplarının her ikisinde de sağlıklı kontrol grubuna göre olumsuz bilişsel içeriklerin daha yüksek saptanması, bu klinik tablolara sıklıkla eşlik eden depresif belirtilerin varlığını açıklayabilir. Araştırmamızda ortaya çıkan bir diğer sonuç; bu bireylerde, ağrıyla baş etme yöntemi olarak düşünce baskılamadan ziyade, ruminatif tepki biçiminin daha sık kullanıldığıdır.
Maladaptive Cognitive Content and Attitudes Accompanying Tension Type Headache and Migraine
Objective: In this study, we examined the presence of some dysfunctional cognitive contents, processes and attitudes which are supposed to accompany the primary headache and described to take part in psychopathologies like anxiety and depression. Method: Thirty three patients diagnosed with migraine, 34 patients diagnosed with chronic tension type headache according to IHS (International Headache Society) criteria who referred to a Turkish training and research hospital neurology outpatient clinic were included. Thirty three healthy volunteers without headache were included as the control group. Automatic Thought Questionnaire (ATQ), White Bear Suppression Inventory (WBSI), Pain Catastrophizing Scale (PCS) and Demographic Information Questionnaire (DIQ) were administered to the participants for the determination of cognitive contents and attitudes. Results: The results showed that in the tension type headache group, ATQ total scores and ‘’Negative Self-Concepts’’, ‘’Personal Maladjustment and Desire for Change’’ and ‘’Giving up/Helplessness’’ subscale scores were significantly higher than the control group. There was no significant difference between the three groups in WBSI. It was shown that in PCS total scores and all scores of ‘’rumination’’, ‘’magnification’’ and ‘’helplessness’’ subscales, tension type headache group and migraine group had significantly higher scores according to the controls. Conclusion: Higher levels of negative cognitive contents in both of the migraine and tension type headache groups according to the healthy controls can explain high depression frequencies in these clinical manifestations. Another result obtained in our study was that as a way of coping with pain, rumination is used more than thought suppression in these individuals.

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