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Yıl:2003; Cilt: 6; Sayı: 4>> Özet
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Klinik Psikiyatri Dergisi; 2003;6(4):204-212
Panik bozukluğu alt tiplerinin belirtiler açısından araştırılması
S Örsel, O Güriz, A Akdemir, H Türkçapar
SSK Ankara Eğitim Hastanesi, ANKARA
Bu çalışmanın amacı panik bozukluğu olan bir grup hastada panik bozukluğu belirtilerinin dağılımının araştırılarak panik bozukluğu alt tiplerine karşılık gelen panik bozukluğu belirti kümelerinin olup olmadığının belirlenmesidir. SSK Ankara Eğitim Hastanesi’ne başvuran ve DSM-IV Panik Bozukluğu ölçütlerini karşılayan 18-65 yaş arası, çalışmaya katılmayı kabul eden toplam 60 hasta alınmıştır. Belirti Dağılım Anketi, Hamilton Anksiyete Ölçeği, Klinik Global İzlenim Ölçeği uygulanmış ve alt tiplerin varlığı faktör analizi ana bileşenler yöntemi, student-t ve x2 testleriyle araştırılmıştır. En sık saptanan belirtiler çarpıntı, huzursuzluk hissi, ölüm korkusu, titreme, ağız kuruluğu, ümitsizlik ve çaresizlik hissi olmuştur. Bunlardan üçü DSM-IV belirtilerinde yer alırken, özellikle bilişsel belirtiler olan huzursuzluk, ümitsizlik ve çaresizlik hissi yer almamaktadır. Belirti dağılımına göre terleme ve kusmanın kadında daha sık olduğu; şiddet açısından bakıldığında çarpıntı, titreme, uyuşma belirtilerinin yine kadın grubunda istatistiksel olarak daha şiddetli olduğu saptanmıştır. Faktör analizi sonucunda kardiyovasküler, bilişsel, gastrointestinal ve vestibuler belirtiler ile gerginlikle ilgili maddelerin yer aldığı dört faktör elde edilmiştir. Çalışmada üzerinde durulması gereken önemli noktalardan biri hastalar tarafından sık bildirilen huzursuzluk, ümitsizlik, çaresizlik hissi, ağız kuruluğu ve dikkatini toplayamama belirtilerinin DSM-IV dışı belirtiler olmasıdır. Belirtilerin şiddet derecelendirmeleri üzerinde uygulanan faktör analizi sonucunda 4 faktörlü bir model elde edilmiştir. Sonuç olarak panik bozukluğu hastaları değerlendirilirken mevcut tanı sınıflamalarındaki panik atağı belirtilerinin yetersiz olduğu ve alt tipleri belirlemeye uygun olmadığı göz önüne alınmalıdır. Alt tiplerin belirlenmesi panik bozukluğunun gidişi ve tedavi yöntemleri konusundaki çalışmalara katkı sağlayabilir.



The Determination of Panic Disorder Subtypes According to Symptoms
It has been aimed to investigate panic attack symptomatology in a group of panic disorder patients and to determine the subtypes of panic disorder according to symptoms of panic attack. The 60 patients who applied to SSK Ankara Education Hospital and had been diagnosed as DSM-IV panic disorder were recruited in to the study. Panic attack questionnaire, Hamilton Anxiety Scale and Clinical Global impression scale has been applied. The data were analyzed by student t-test, chi-square and factor analysis principal component method. Heart pounding, feelings of discomfort, trembling, dry mouth, feelings of helplessness and hopelessness symptoms were the most frequent symptoms. While three of them were DSM-IV symptoms, the others especially feelings of discomfort and helplessness were non DSM-IV symptoms. According to symptom dispersion, sweating and nausea were significantly more frequent in women; also the severity of heart pounding, trembling and parestesias symptoms were higher in women with respect to severity of symptoms. Factor analysis revealed four subtypes such as cardio-vasculer, cognitive, gastrointestinal and tense-related symptoms. One of the most important findings of our study is some of the most frequent symptoms such as the feelings of discomfort, helplessness, hopelessness were non DSM-IV symptoms. Principal component factor analysis that was used on the severity ratings of symptoms revealed a four factor subtypes. As a result, when we evaluate panic disorder patients we have to pay attention that DSM-IV panic disorder symptoms were not sufficient for determining the subtypes. The studies of outcome and treatment of panic disorder would be productive by determining the subtypes of panic disorder.

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