Nöropsikiyatri Arşivi; 2014;51(3):233-241
Majör Depresif Bozukluğun Klinik Görünümünde Boyutsal ve Kategorik Sınıflandırmanın Etkileri
H Güleç, A Karabekiroğlu, A Yenel, MB Baykaran, EK Ünal
Erenköy Psychiatric and Neurological Disorders Training and Research Hospital, İstanbul
Introduction: The aim of this study was to combine the dimensional concept
with the categorical system in major depressive disorder (MDD) to reduce the
complexity of the diagnosis. Furthermore, it was aimed to match categorical and
dimensional approaches in a clear and simple manner.
Method:
The study included a patient group of 131 consecutive outpatients
diagnosed with MDD according to the DSM-IV diagnosis criteria, and a control
group of 99 people that is matched with the patient group by gender, age and
education level. All subjects completed the Beck Depression Inventory, the
Beck Anxiety Inventory and the Toronto Alexithymia Scale (TAS).
Results:
Cronbach’s alpha values for the analysis of the internal consistency of
the scale for the patients group, control group and the total participants were
determined as 0.94-0.97, 0.87-0.92 and 0.93-0.96, respectively. Nine factors were
obtained from the results of exploratory factor analysis. According to the Screeplot,
it was decided that the two-factor structure represents best. Although
depression and anxiety are two distinct dimensions, the relationship between
them was found to be significantly significant. This was valid for both patient
and control groups. When the relationship between the DSM-IV diagnosis
criteria and all variables (depression and its sub-dimensions, anxiety and its
sub-dimensions and the number of symptoms) was evaluated, the number of
symptoms was found to be significantly related with all of the criteria.
Conclusion:
The number of symptoms and the severity of illness are found to be
important in the clinical manifestation of MDD. The relationship of the severity
of the illness with sleep and appetite seems weaker. While loss of interest was
mainly predicting the disorder, weight changes, psychomotor changes, difficulty
in concentration, fatigue, and worthlessness were determined not to be
predictors of the manifestations. According to dimensional approach, somatic
anxiety and deterioration in performance predict the presence of the disorder.
According to categorical and dimensional approaches, some of the DSM-IV
criteria (#2, #1, #9, #4, number of symptoms, severity of symptoms, somatic
anxiety, performance deterioration) are seen to contribute to the matchability
between the approaches.
Effects of Dimensional and Categorical Classification on the Clinical Manifestation of Major Depressive Disorder
Giris: Bu çalismada Majör Depresif Bozukluk (MDB)’un tanisal karmasasini
azaltmak için boyutsal kavramlari kategorik sistemle birlestirme amaciyla
teorik düzeyin yani sira kategorik ve boyutsal yaklasimlar arasinda açik ve basit
eslenebilirlik arastirildi.
Yöntem:
Bu çalismaya ayaktan basvuran 131 ardisik DSM-IV tani ölçütlerine
göre MDB tanisi konmus hasta yas, cinsiyet ve egitim olarak eslestirilmis 99
saglikli kontrol alindi. Tüm katilimcilara Beck Depresyon Ölçegi, Beck Anksiyete
Ölçegi ve Toronto Aleksitimi Ölçegi verildi.
Bulgular:
Hasta, kontrol ve toplam tüm gruptaki depresyon ve anksiyete ölçeginin
iç tutarligi analizinde Cronbach alfa degerlerinin sirasiyla, 0,94-0,97; 0,87-0,92 ve
0,93-0,96 arasinda oldugu saptandi. Açimlayici faktör analizi sonuçlarina göre
9 faktör elde edildi. Scree grafigi egrisinin belirgin olarak degisimine bakilarak
iki faktörlü yapinin en iyi açikladigina karar verildi. Depresyon ve anksiyetenin
birbirinden ayri iki farkli boyut olmasina ragmen birbirleri ile arasindaki iliskinin
oldukça yüksek oldugu, bu durumu hem hasta hem de saglikli gruplarin sagladigi
belirlendi. DSM-IV’e göre her bir tani ölçütünün degiskenlerle olan iliskilerine
bakildiginda, hem depresyon hem de anksiyete alt-boyutlariyla ve halen
sürmekte olan belirti sayisi ile olan iliskilerinde; belirti sayisinin tüm ölçütlerle
güçlü iliskide oldugu bulundu.
Sonuç:
Belirti sayisi ve hastalik siddetinin, MDB klinik görünümünde önemli
oldugu görülmektedir. Hastalik siddetiyle uyku ve istah arasindaki iliskinin
zayif oldugu görülmektedir. Ilgi kaybinin hastalik varligini en fazla yordarken;
kilo degisikligi, psikomotor degisim, yorgunluk, degersizlik ve yogunlasma
güçlügü hastalik varligini yordamamaktadir. Boyutsal yaklasima göre somatik
anksiyete ve performansta bozulma hastalik varligini yordamaktadir. Kategorik
ve boyutsal yaklasimda; DSM-IV ölçütlerinde yer alan bazi maddelerin (#2, #1,
#9 ve #4), belirti sayisinin, hastalik siddetinin, somatik anksiyete ve performansta
bozulmanin yaklasimlar arasi eslenebilirlige katkisi olabilecegini göstermektedir