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Yıl:2014; Cilt: 51; Sayı: 4>> Özet
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Nöropsikiyatri Arşivi; 2014;51(4):334-343
Çocukluk Çağı Başlangıçlı Obsesif Kompulsif Bozukluk Tanılı Çocuk ve Ergenlerde Klinik ve Nöropsikolojik Özelliklerin İncelenmesi
S Baykal, K Karabekiroğlu, A Şenses, MN Karakurt, T Çalık, M Yüce
Dumlupınar Üniversitesi, Kütahya, Türkiye
Giriş: Çocukluk Çağı Başlangıçlı Obsesif Kompulsif Bozukluk’un (OKB), Erişkin Başlangıçlı OKB’den gösterdiği farklar son yıllarda klinisyenlerin ilgi odağı olmaya başlamıştır. Bu çalışmanın amacı Çocukluk Çağı Başlangıçlı OKB tanısı konan çocuk ve ergenlerin klinik ve nöropsikolojik özelliklerini belirlemek, OKB tanısının hastalık süresi, şiddeti, ek tanılar ve ailede OKB öyküsü bulunmasının klinik ve nöropsikolojik işlevlerdeki bozukluk ile ilişkilerini incelemektir. Yöntem: Çalışmaya yaşları 8-15 arası olan 35 OKB olgusu (hasta grubu) ve sağlıklı 35 çocuk ve ergen (kontrol grubu) alınmıştır. Her bir katılımcıya; nöropsikolojik profillerini belirlemek amacı ile Wisconsin Kart Eşleme Testi (WKET), Stroop Testi ve Sürekli Performans Testi (SPT) uygulanmış, klinik ve davranışsal profillerini değerlendirmek için Çocuklar İçin Depresyon Değerlendirme Ölçeği (ÇDÖ), Conner’s Ana\Baba Derecelendirme Ölçeği (CADÖ-48), Yale Brown Obsesyon ve Kompulsiyon Ölçeği (ÇYBOKÖ), Yale Genel Tik Ağırlığını Değerlendirme Ölçeği (YGTDÖ) verilmiştir. Tartışma: Bulgular, OKB tanısının hastalık süresi, şiddeti, ek tanılar ve kaygı puanlarından bağımsız olarak yürütücü işlevler, dikkat ve motor inhibisyon süreçlerini bozduğu, ailede OKB öyküsü bulunmasının tüm bu parametreler üzerine etkili en önemli risk faktörü olduğunu göstermiştir. Çocukluk çağı başlangıçlı OKB olgularının uzun süreli takibi hastalığın kognitif fonksiyonlar üzerindeki sebep-sonuç ilişkisini değerlendirmek için bir sonraki çalışma adımı olmalıdır. Sonuç: Çalışmamızdaki WKET, Stroop Testi ve SPT sonuçları ışığında, Çocukluk Çağı Başlangıçlı OKB tanılı bireylerin sağlıklı kontrollere göre yürütücü işlevler, sürdürülen dikkat ve motor inhibisyon görevlerinde istatistiksel olarak anlamlı düzeyde daha kötü performans gösterdiği saptanmıştır. Çocukluk Çağı Başlangıçlı OKB tanılı çocuk ve ergenlerin ek tanılar dışlandığında davranışsal sorun alanlarında sağlıklı kontrollerden farklılık göstermedikleri, ancak kaygı düzeylerinin daha yüksek olduğu görülmüştür.
Neuropsychological and Clinical Profiles of Children and Adolescents Diagnosed with Childhood ObsessiveCompulsive Disorder
Introduction: The differential features of childhood-onset obsessive compulsive disorder (OCD) compared to adult-onset OCD are being more of a focus of attention in recent years. The aim of this study was to determine the clinical and neuropsychological profiles of children and adolescents diagnosed with childhood-onset OCD and to investigate the association between the duration, severity, comorbidity, and family history of the disorder and clinical and neuropsychological functional impairments. Methods: Thirty-five OCD patients (patient group) and 35 healthy control subjects (control group) between 8-15 years of age were included. To investigate the neuropsychological profiles, the Wisconsin Card Sorting Test (WCST), Stroop Test, and Continuous Performance Test (CPT) were applied. To assess the clinical and behavioral profiles, the Children’s Depression Inventory (CDI), Conner’s Parent Rating Scale (CPRS-48), and the Yale Brown Obsessive Compulsive Scale (YB-OCS) and Yale Global Tic Severity Rating Scale (YGTSRS) were given. Results: Based on the performance in the WCST, Stroop Test, and SPT, the results of the study reveal that childhood-onset OCD patients have statistically significant worse performance compared to healthy controls in terms of executive functions, sustained attention, and motor inhibition tasks. Excluding the comorbid diagnoses, childhood-onset OCD patients did not show a difference in behavioral problems, but they had higher levels of anxiety compared to healthy controls. Conclusion: The findings of this study reveal that independent of the duration, severity, comorbid problems, and anxiety levels, the disorder itself is associated with worse performance in executive functions, attention, and motor inhibition processes, and a positive family history of OCD is an important risk factor. Long-term follow-up studies with patients diagnosed with childhood-onset OCD would be a logical next step in order to determine the cause-effect relation between the disorder and cognitive impairments.

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