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Yıl:2012; Cilt: 2; Sayı: 2>> Özet
Psikiyatride Güncel; 2012;2(2):135-146
Genel tıbbi değerlendirme ve laboratuvar incelemelerinin psikiyatrik vaka formülasyonuna katkısı
HD Özgüven
Ankara Üniversitesi, Ankara
Psikiyatride öykü alma ve dikkatli bir muayene hâlâ en önemli tanı aracıdır ve klinik değerlendirmenin temelini oluşturur. Laboratuvar testlerinin psikiyatrik hastalıkların tanısında herhangi bir patognomonik değeri, tanı koydurucu özelliği yoktur. Yine de psikiyatri alanında laboratuvar incelemelerinin kullanımının giderek arttığı bir gerçektir. Laboratuvar testleri daha çok ayırıcı tanı amacıyla, başlanacak bir tedavi öncesinde tarama yapmak için ya da çeşitli tedavilerin yan etkilerini izlemek üzere kullanılmaktadır. Psikiyatrik hastalıklar patognomonik belirtilerin olmadığı, herhangi bir tanı koydurucu belirtecin bulunmadığı, sendromal nitelikte ve belirti kümelerine dayanan tanılardır. Laboratuvar testlerinin hastaya tanı koyma aşamasındaki yeri ise, söz konusu belirtilerin ortaya çıkmasına yol açan başka tıbbi hastalıkların dışlanmasıdır. Bunun yanında bazı tedavilere başlamadan önce yapılması gereken laboratuvar testleri vardır. Bu testler hastaya başlanması düşünülen tedavinin, varsa kontrendikasyonlarının saptanması, olası tedaviler arasında uygun olanın belirlenmesi ve uygulanacak tedavilerin yan etkilerinin izlenebilmesi için, tedavi başlamadan önceki laboratuvar değerlerinin saptanıp kaydedilmesi amacıyla yapılır. Daha sonra da bu laboratuvar incelemeleri, tedavi yan etkilerinin izlenmesi amacıyla belirli aralıklarla tekrarlanır. Psikiyatrik tedavilerin optimize edilmesi, terapötik indeksi dar ilaçların olası toksisitelerinin önlenmesi ve ilaç uyumunun sağlanması bakımından çok yararlı bir başka uygulama da plazma ilaç düzeylerinin izlenmesidir. Psikiyatride kullanılan az sayıda ilacın plazma düzeyine rutin biçimde bakılabilmekte, bu ilaçların başında duygudurum düzenleyiciler gelmektedir.
General medical assessment and laboratory examinations in psychiatric case formulation
Clinical history and a thorough examination are the only indispensable diagnostic tools in psychiatry. However, laboratory tests can aid psychiatric diagnosis, and their use in psychiatry is expanding. Unfortunately, no single laboratory test is yet of pathognomonic value in psychiatry. The most common use of laboratory examinations is in the process of differential diagnosis. General medical assessment prior to the initiation of pharmacotherapy and monitorization of side effects during pharmacotherapy also involve laboratory testing. Psychiatric disorders have no pathognomonic symptoms or diagnostic markers, and are based on definitions of symptom clusters. Thus, laboratory tests also help in the exclusion of general medical conditions that present with psychiatric symptoms. Baseline laboratory values are needed before the initiation of pharmacotherapy with the aim of detecting any contraindications. They are also used as the basis against which follow-up values can be compared in monitoring medication side effects. Monitoring plasma levels of psychotropic medications is very useful in optimizing drug dosage, preventing potential toxicity of the medications that have a low therapeutic index, and as a reliable indicator of medication compliance. Mood stabilizers require regular testing of plasma values, and are probably the medications for which routine monitoring is most widely performed.

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