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Yıl:2015; Cilt: 5; Sayı: 3>> Özet
TAM METİN
Journal of Mood Disorders; 2015;5(3):126-133
Dikkat eksikliği / hiperaktivite bozukluğu ve major depresif bozukluk tanılı erişkin hastalarda bağlanma biçimlerinin karşılaştırılması: Kontrollü bir ön çalışma
E Özten, EA Tufan, GH Sayar, G Eryılmaz, D Aloğlu, S Işık
Üsküdar Üniversitesi, İstanbul
Amaç: Yapılmış çalışmaların sonucunda bağlanma örüntüsünün erişkinlerde hem dikkat eksikliği hiperaktivite bozukluğu (DEHB) hem de majör depresif bozukluk (MDB) gelişimi ve gidişinde önemli rol oynadığı gösterilmiştir. Bu araştırmada DEHB ve MDB tanısı alan erişkin bireylerde bağlanma biçimleri ve ilişkili etmenlerin karşılaştırılması amaçlanmıştır. Yöntem: Bu araştırma Haziran 2014 - Ekim 2014 tarihleri arasında İstanbul’da ikinci basamak bir tedavi merkezinin psikiyatri polikliniğinde yürütülmüştür. Belirtilen zaman aralıkları içerisinde ilk kez polikliniğe başvuran SCID-I (DSM-IV Eksen I Bozuklukları İçin Yapılandırılmış Klinik Görüşme) uygulanarak MDB tanısı konan 31, DEHB tanısı konan 33 kişi ve yaş, cinsiyet, eğitim ve medeni durumları bakımından eşlenmiş 31 sağlıklı kontrol araştırmaya dâhil edilmiştir. MDB ve DEHB tanılı gruplar klinisyen tarafından doldurulan Klinik Global Değerlendirme Ölçeği (CGI-S) puanlarına göre eşlenmiştir. Katılımcılara DSM-IV’e Dayalı Erişkin DEB/DEHB Tanı ve Değerlendirme Envanteri (E-DEHB) doldurtulmuştur. E-DEHB’de 1. veya 2. bölümdeki 9’ar sorudan en az altı tanesine 2 veya 3 puan verenlere tekrar klinik görüşme yapılarak DEHB tanısı araştırılmış ve DSM-IV-TR ölçütlerine göre erişkin DEHB tanısı konulmuştur. Ayrıca klinisyen tarafından Hamilton Depresyon Ölçeği (HAM-D) uygulanmıştır. Tüm katılımcılara Yakın İlişkilerde Yaşantılar Envanteri (YİYE) doldurtulmuştur. Bulgular: Üç grup arasında YİYE ile saptanan kaygılı bağlanma alt tipi puanları açısından anlamlı farklılık bulunmuştur. MDB grubunun sağlıklı kontrollerden kaygılı bağlanma puanlarında anlamlı fark gösterdiği ancak DEHB grubundan farklılık göstermediği saptanmıştır. Üç grupta kaygılı, kaçıngan ve güvenli bağlanan kişi sayıları arasında istatistiki olarak anlamlı farklılık saptanmamıştır. Kaygılı bağlanma oranları ile E-DEHB hiperaktivite alt ölçek (E-DEHB-HA) puanları (p= 0.007, r= 0.463) ve HAM-D puanlarının (p= 0.046, r= 0.361) anlamlı pozitif korelasyon gösterdiği görülmüştür. Buna karşılık kaçıngan bağlanma oranları ise E-DEHB dikkat eksikliği hiperaktivite bozukluğu ile ilişkili özellikler puanları (E-DEHB-İÖ) ile (p= 0.002, r= 0.402) anlamlı ve pozitif korelasyon göstermektedir. Sonuç: Bu araştırmada geçmiş çalışmaların aksine DEHB tanılı grup, MDB grubu ve sağlıklı kontrol grubundan bağlanma örüntüleri bakımından farklı bulunmamıştır. Bu bulgu kullanılan ölçeklere, seçilen yaş grubuna veya örneklemde kadınların baskınlığına bağlı olabilir. Ancak MDB grubunun sağlıklı kontrol grubuna göre kaygılı bağlanma örüntüsünü daha sık sergilediği sonucuna ulaşılmıştır. Güvensiz bağlanmanın MDB tanısının gelişimini kolaylaştırabileceği, gelişmiş olan bozukluğun devamını sağlayabileceği ve terapiyi olumsuz etkileyebileceği söylenebilir.
Comparison of attachment styles in adult patients with attention deficit hyperactivity disorder and major depressive disorder: a controlled preliminary study
Aim: As a result of previous studies, it was demonstrated that attachment patterns in adults play an important role in the development and course of both attention deficit hyperactivity disorder (ADHD) and major depressive disorder (MDD). The aim of this study is to compare the attachment styles and related factors in the adults diagnosed with ADHD and MDD. Method: This study was carried out in psychiatry outpatient clinic of a second stage treatment center between June 2014 and October 2014 in Istanbul. The study included 33 ADHD patients, 31 MDD patients who first time admitted to the clinic within the specified time intervals and were applied SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders), and 31 healthy controls matched in terms of age, gender and marital status. MDB and ADHD groups were matched according to their Clinical Global Impression Scale (CGI-S) scores which have been applied by clinicians. DSM-IV-based Adult ADD/ADHD Diagnosis and Assessment Inventory (E-ADHD) has been filled by the participants. Those who gave 2 or 3 points to at least six of the nine questions of 1st or 2nd sections of E-ADHD were once again interviewed clinically in terms of ADHD, and were diagnosed with adult ADHD according to DSM-IV-TR criteria. Additionally, Hamilton Depression Scale (HAM-D) was applied by the clinician. All of the participants filled Experiences in Close Relationships (ECR) Inventory. Results: Significant differences were found between the three groups in terms of anxious attachment subtype scores determined through ECR. A significant difference in anxious attachment scores was found in MDD group when compared with healthy controls, whereas there wasn’t any difference between ADHD group and healthy controls. There weren’t any statistically significant differences between the number of people in terms of anxious, avoidant and secure attachment in three groups. There was a significant positive correlation between anxious attachment rates and E-ADHD hyperactivity subscale (E-ADHD-HA) scores (p= 0.007, r= 0.463) and HAM-D scores (p= 0.046, r= 0.361). There was a significant positive correlation between avoidant attachment rates and E-ADHD attention deficit hyperactivity disorder related features scores (E-ADHD-RF) (p= 0.002, r= 0.402). Conclusion: In this study, in contrast to previous studies, there weren’t any differences in terms of attachment patterns between the ADHD group, the MDD group and healthy controls. This finding might depend on the scale used, the age of the group or the predominance of women in the sample. However, it was concluded that MDD group exhibited anxious attachment pattern more frequently than the healthy control group. It can be said that insecure attachment may facilitate the development of MDD, may lead to progression of the disorder, and may affect the therapy negatively.

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