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Yıl:2015; Cilt: 52; Sayı: 4>> Özet
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Nöropsikiyatri Arşivi; 2015;52(4):336-341
Nörotik Ekskoriyasyon Hastalarında Psikiyatrik Özellikler: Çocukluk Çağı Travmalarının Rolü
M Yalçın, E Tellioğlu, DU Yıldırım, BM Savrun, M Özmen, EH Aydemir
Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul
Amaç: Nörotik Ekskoriyasyon (NE) primer psikolojik/psikiyatrik nedenli olan ve kendine zarar verme ile oluşan psikodermatolojik bir hastalıktır. Çocukluk çağı travmatik yaşantılarının kendine zarar verme davranışlarıyla yakından ilişkili olduğu bilinmektedir. Bu çalışmanın amacı NE hastalarında psikiyatrik özelliklerin saptanması ve çocukluk çağı travmatik yaşantılarının hastalığa olan etkisinin incelenmesidir. Yöntem: Çalışmaya 18-65 yaş arasında iki deneyimli dermatolog tarafından muayene edilerek NE tanısı almış, son bir yıl içinde herhangi bir psikiyatrik tedavi almamış 38 hasta ve benzer sosyodemografik özellikler gösteren sağlıklı 40 kişi dahil edilmiştir. Klinik değerlendirme için DSM IV-TR için yapılandırılmış klinik görüşme Envanteri SCID-I, Beck Anksiyete Ölçeği (BAÖ), Beck Depresyon Ölçeği (BDÖ) ve Çocukluk Çağı Travmaları Ölçeği-Kısa Form (CTQ-28) uygulanmıştır. Bulgular: Çalışmamızda hasta grubunda BAÖ ve BDÖ skorlarının sağlıklı bireylere göre anlamlı olarak yüksek olduğu görülmüştür (p<0,05). NE olgularının %78.9’unun en az bir tane Eksen I psikiyatrik tanı aldığı, en sık görülen psikiyatrik tanıların majör depresyon ve anksiyete bozuklukları olduğu saptanmıştır. ÇTQ-28 skorları incelendiğinde ise NE hastalarında Duygusal İhmal, Duygusal Kötüye Kullanım ve Fiziksel Kötüye Kullanım alt ölçekleri ile Ağırlıklı Toplam Ortalama Puan skorları anlamlı olarak yüksek bulunmuştur (p<0,05). Cinsel Kötüye Kullanım ve Fiziksel İhmal alt ölçeği skorlarında ise her iki grup arasında anlamlı bir fark gözlenmemiştir (p>0,05). Hasta grubunda CTQ-28 Ağırlıklı Toplam Ortalama Puan ve alt ölçek skorlarının, anksiyete ve depresyon düzeyleriyle de pozitif yönde ilişkili olduğu görülmüştür. Sonuç: NE hastalarında anksiyete ve depresyon düzeyleri belirgin olarak yüksekti, ve özellikle depresyon ve anksiyete bozukluğu gibi psikiyatrik tanılar hastalığa yüksek oranda eşlik etmekteydi. NE hastaları çocukluk çağı travmatik yaşantıları açısından kontrol grubu ile farklılık gösterdi, ve NE hastalarında travma skorları, anksiyete ve depresyon düzeyleri ile ilişkili bulundu. Çalışmamızın sonuçları çocukluk çağı travmalarının hem NE hem de eşlik eden psikiyatrik sorunların oluşumda önemli bir rolü olabileceğini göstermiştir. NE olgularında çocukluk çağı travmatik yaşantılarının ayrıntılı sorgulanması oldukça önem arz ettiğini ve psikoterapötik müdahalelerin kullanılması ile birçok hastanın tedavisinde daha iyi sonuçlar elde edilebileceği düşünmekteyiz.
Psychiatric Features in Neurotic Excoriation Patients: The Role of Childhood Trauma
Introduction: Neurotic excoriation is a psychodermatological disease of primary psychological/psychiatric genesis, responsible for self-induced dermatological disorders. Childhood traumatic events are closely related with self-injurious behaviors. The aim of this study is to evaluate the psychiatric features of neurotic excoriation and to investigate the effect of childhood traumatic events on the disease. Methods: Thirty-eight neurotic excoriation patients who did not receive any psychiatric treatment within the past year and 40 healthy individuals having similar sociodemographic features were included in the study. For clinical evaluation, the Structured Clinical Interview for DSM-IV Axis I Disorders, Beck Depression Inventory, Beck Anxiety Inventory, and Childhood Trauma Questionnaire-Short Form were applied to all the individuals. Results: In this study, we observed that 78.9% of neurotic excoriation patients were diagnosed with at least one Axis I psychiatric disorder, the most frequent diagnoses of which were major depressive disorders and anxiety disorders. The anxiety and depression levels were significantly higher in the patient group than in the healthy individuals. Regarding the Childhood Trauma Questionnaire, emotional neglect, emotional abuse, and physical abuse subscales and weighted average total scores were found to be significantly higher in the patient group (p<.05). Conclusion: Our study has shown a close relationship between neurotic excoriation and childhood traumatic events as well as the accompanying psychiatric problems. We suppose that early interventions by both dermatologists and psychiatrists and especially a detailed investigation of childhood traumatic events by establishing a therapeutic collaboration are highly important and that using psychotherapeutic interventions can result in better treatment outcomes in many patients.

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