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Yıl:2014; Cilt: 4; Sayı: 1>> Özet
Psikiyatride Güncel; 2014;4(1):50-61
Çocuk ve ergenlerde duygudurum bozuklukları
YI Taner
Gazi Üniversitesi, Ankara
Çocuk ve ergenlik döneminde depresyon oldukça sık görülen, tekrarlarla giden ve süregelen okul başarısını, aile ve arkadaş ilişkilerini önemli oranda etkileyen bir psikopatolojidir. Etiyolojisinde ailesel geçişin önemli rolü olduğu düşünülmekle birlikte, psikososyal etmenler ve kronik hastalıkların etkili olduğu bilinmektedir. Çocukluk çağında depresif belirtiler yaş dönemine ve cinsiyete göre farklılık göstermektedir. Genellikle tekrarlarla seyreden bir bozukluk olup, hastalık kronikleşmesi pek çok faktörle ilişkili bulunmuştur. Çocuk ve ergenlerdeki depresyonun değerlendirilmesi ve tedavisinde çocuk ve klinisyen arasında her şeyden önce güvenilir bir ilişki oluşmalıdır. Uygun tedavi seçiminde hastalığın şiddetinin belirlenmesi önemlidir. Hafif depresyon tablolarında, destek, psikoeğitim ve izlem tedavisi yeterli olurken, orta-ağır depresyon tablolarında psikoterapi ve/veya antidepresan ilaçlardan yararlanılır. Çocuk ve ergenlerde görülen depresyonun tedavisinde en yaygın olarak kullanılan ve ilk tercih edilmesi gereken ajanlar SSRI’lardır. Bipolar bozukluk, çocuk ve ergenlerde işlevselliği önemli derecede etkileyen, kronik seyirli bir bozukluktur. Bu nedenle de çocukluk ve gençlik yıllarında bipolar bozukluğun tanınması ve tedavi edilmesi özel öneme sahiptir. Bipolar bozukluk psikiyatrik hastalıklar içinde genetik geçişin önemli rol oynadığı bozukluklardan biridir. Bipolar bozukluğu olan çocuk ve ergenlerle yapılan beyin görüntüleme çalışmalarında hem yapısal hem de fonksiyonel değişikler olduğu gösterilmiştir. Çocuk ve ergenlerdeki erken başlangıçlı bipolar bozukluğun temel klinik özellikleri; uzun epizodlar ve kronik gidiş, karma epizodlar ve/veya hızlı döngü ve eşlik eden belirgin iritabilitedir. Bipolar bozukluğun ilk ortaya çıktığı zaman doğru olarak tanınıp, tedavi edilmesi, ileriki yıllarda hastalığın gidişini önemli ölçüde etkilemektedir. Tedavinin temelinin farmakolojik tedavi oluşturmaktadır; antipsikotikler, antikonvulzanlar ve lityum yaygın olarak kullanılan ilaçlardır.
Mood disorders in childhood and adolescence
Depression is one of the psycho-pathologies which occurs commonly in the period of childhood and adolescence and affects school success and family/friendship relations. In addition to genetical factors, psychosocial adversities should be considered as etiological factors. Depressive symptoms in childhood and adolescence period may differ with age or gender. Depression is usually a chronic disorder. In order to correctly evaluate and treat the disorder, a reliable relationship must be established between the patient and the clinician in the first place. It is important to determine the intensity of the disorder in order to select suitable treatment For mild depressive disorders, supportive psycho-education and patient follow-up is sufficient while for moderate/severe depressive disorders psychotherapy and/or medicines can be used. SSRIs are the agents that should be considered in the first place in the treatment of depression in childhood and adolescence. Bipolar disorder is an important chronic disorder which affects functionality in all areas in childhood and adolescence. As it is a serious disorder, it is important to diagnose and treat bipolar disorder in childhood and adolescence years. Bipolar disorder is a disease in which genetical transition has an important effect. Functional and structural changes in the brain are illustrated to exist by brain scanning studies of child and adolescent patients with bipolar disorder. The primary clinical properties of pediatric bipolar disorders can be listed as long episodes with chronic progress, mixed episodes and/or fast cycles with accompanying irritation. Properly diagnosing and treating the disease from the beginning importantly affect the prognosis in the following years. The main basis of the treatment is using pharmacological treatment; antipsychotics and anticonvulsants and lithium are commonly used agents.

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