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Yıl:2004; Cilt: 7; Sayı: 2>> Özet
TAM METİN
Klinik Psikiyatri Dergisi; 2004;7(2):111-119
Alkol/madde kullanım bozukluğunda kişilik bozukluğu ek tanısı: Bir gözden geçirme
EC Evren
Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Araştırma ve Uygulama Hastanesi, AMATEM Kliniği, İstanbul
Alkol/madde kulanım bozukluklarına sıklıkla kişilik bozukluğu eşlik etmektedir. Bu gözden geçirme yazısında Alkol/madde kulanım bozuklukları ile birlikte kişilik bozukluğu bulunduğu durumların yaygınlığı; bu konuda yapılan çalışmaların yöntem sorunları; etiyolojik kuramlar; ek tanının alkol/madde kulanım bozukluklarının gidişine ve belirtileri üzerine olan etkisi ve tedavi yaklaşımları ele alınmıştır. Literatür araştırması bilgisayar aracılığı ile Amerikan Ulusal Tıp Kütüphanesi (National Library of Medicine) Medline dosyası taranarak yapılmıştır. Günlük pratikte alkol/madde kulanım bozuklukları ve kişilik bozukluğu ek tanısı ile sıklıkla karşılaşmakla birlikte kesin tanı konulmamakta ve bu tedavide değişikliğe yol açmamaktadır. B kümesi alkol/madde kulanım bozukluğu olanlarda en sık saptanan kişilik bozukluğu kümesi olmaktadır. Bu kümede de en sık tanı antisos­yal ve borderline kişilik bozuklukları olmaktadır. Kişilik bozukluğu ek tanısı alanların almayanlar kadar tedaviden faydalanabilme­lerine rağmen, kişilik bozukluğu ek tanısı, alkol/madde kulanım bozuklukluğu olanlarda depreşmeyi belirleyebilmektedir. Kişilik bozukluğu ek tanısı I. Eksen ek tanısı riskini de arttırmaktadır. Alkol/madde kulanım bozukluklarıda Mizaç ve Karakter Envanteri ile ölçü­len ?kendi kendini yönetme? düşük puan alma, yüksek kişilik bozukluğu olasılığını göstermektedir. Kişiliğin alkol/madde kulanım bozuklukları üzerindeki rolünün araştırılması, alkol/madde kulanım bozuklukları gelişme riski yüksek bireylerin tanımlanmasına yardımcı olabileceği gibi, yardım için başvurmuş farklı bireylerin farklı tedaviler için eşleştirilmesine fayda sağlayabilir. Ülkemizde alkol dışı madde kullanım bozukluğu olanlarda yapılacak çalışmalara ihtiyaç vardır. Kişilik bozukluğu ek tanısı olan hastalara tedavi yaklaşımı farklı olmalıdır. Her iki durumun tedavisi aynı anda olmadığı takdirde tedavide başarılı olmak mümkün görünmemektedir.
Personality Disorder Comorbidity in Alcohol/Substance Use Disorders: A Review
Personality disorder comorbidity is common among patients with substance use disorder. This article reviews the prevalence of comorbid personality disorder in alcohol/substance use disorders, methodological problems while examining this topic, etiological models, the impact of personality disorder on course and outcome of substance use disorders and treatment of this comorbid conditions. The literature search was conducted through the Medline records of the National Library of Medicine. Substance use disorder and personality disorder comorbidity is common in clinical practice, although this does not result with clear diagnosis of these patients or change in treatment approach. Most prevalent personality disorder cluster diagnosis is cluster B in substance use disorders. Among cluster B most prevalent diagnosis is antisocial and borderline personality disorders. Although patients with comorbid personality disorders benefit from treatment as much as those patients without comorbidity, personality comorbidity predicts relapse in these patients. Comorbidity of personality disorders also rises the risk of axis I disorder comorbidity. Having low 's elf directedness? score on Temperament and Character Inventory (TCI) is related with high personality disorder risk among patients with substance use disorders. Examining effects of personality on substance use disorders will help clarify individuals with high risk of substance use disorder and also will help to match the treatment seeking individual with different treatment approach. Studies to evaluate personality disorders in drug use disorders are needed in Turkey. Treatment approach must be different in patients with comorbid personality disorder. Treatment may not be successful if both disorders are not treated at the same time.

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