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Yıl:2014; Cilt: 4; Sayı: 3>> Özet
Psikiyatride Güncel; 2014;4(3):282-289
Obsesif kompulsif bozuklukta özeldurumlar ve tedavisi (Gebelik, doğum sonrası dönem ve yașlılık)
S Tümkaya, H Alaçam
Pamukkale Üniversitesi, Denizli
Genel olarak gebelik ve doğum sonrası dönemde obsesif kompulsif bozukluğun (OKB) sık görüldüğü düşünülmektedir. OKB’nin 50 yaşından sonra başlaması ise nadir görülen bir durumdur ve genellikle organik bir nedene bağlıdır. Çalışmalar gebelik ve doğum sonrası dönemde özellikle bebekle ilgili saldırganlık obsesyonlarının sık görüldüğüne işaret etmektedir. Daha önce OKB’ si olan hastalarda doğum sonrası dönemde OKB belirtilerinde artma ve azalma bildiren çalışmalar mevcuttur. Bu dönemde başlayan OKB olgularında genellikle ani başlangıç bildirilmiştir. Bu ani başlangıcın doğum sonrasında gonadal steroid hormonların aniden azalmasının serotonerjik sistemi etkilemesi sonucunda olabileceği düşünülmektedir. Gebelik ve doğum sonrası dönemde OKB tedavisinde uygun olgularda bilişsel davranışçı terapi (BDT) kullanılabilir. Gebelik ve emzirme dönemlerinde görülen OKB hastalarında bebeğin güvenliği ile ilgili kaygıların olması OKB’nin ilaçla tedavisini güçleştirmektedir. İlaç tedavisi düşünülen hastalarda seçici serotonin gerialım inhibitörleri (SSGİ) ilk seçenektir ve kar zarar oranı gözetilerek ve hastalar ilaçların olası yan etkileri konusunda bilgilendirilerek başlanmalıdır. Dirençli olgularda antipsikotikler de kullanılmaktadır. Yaşlılık döneminde başlayan OKB’de organik etiyoloji göz önünde tutulmalı ve buna yönelik tetkikler yapılmalıdır. Yaşlılarda da ilk ilaç seçeneği SSGİ’lerdir. Altta yatan organik etiyolojinin olduğu vakalarda SSGİ’lerin faydalı olup olmayacağına ilişkin kanıtlar çelişkilidir. Yaşlı hastalarda metabolizmanın yavaş olması nedeni ile antidepresan ilaçlar normalde kullanılan dozlardan daha düşük dozda başlanmalı ve yavaş yavaş titre edilmelidir. Ayrıca, bu hastalar genellikle başka ilaçlar da kullandıkları için ilaç etkileşimlerine dikkat etmek gereklidir.
Special conditions in obsessive-compulsive disorder and treatment (Pregnancy, postpartum period and elderly)
Generally, it has been thought that obsessive-compulsive disorder (OCD) is frequently seen in pregnancy and postpartum period. OCD is rarely seen after age of 50 and usually caused by an organic factor. Studies have shown that aggressive obsessions are frequently seen especially in pregnancy and postpartum period. Also studies have shown that increase and decrease of OCD symptoms in postpartum period are seen in patients who previously had OCD. It is noticed that symptoms of OCD cases start in this period usually starts abruptly, and this abrupt start has been considered as a possible result of effects of abruptly decreased steroid hormones on serotonergic system. In pregnancy and postpartum period, cognitive behavioral therapy (CBT) can be used in OCD treatment for proper cases. Baby’s safety worries in OCD, which is seen in pregnancy and lactation period, makes medical treatment difficult for patients. Selective serotonin reuptake inhibitors (SSRI) is first option for patients who are considered for medical treatment, rate of profit should be considered and patients should be notified about medicines’ side effects. Antipsychotics drugs also used in resistant cases. For OCD cases, which start at old ages, organic etiology should be considered and examinations should be done. First medical drug option is SSRI for old patients. For cases, which have organic etiology, evidences are conflicting about whether SSRIs are effective or not. Antidepressant drugs should be started less than regular doses for old patients, because of their slow metabolism, and should be slowly increased. Furthermore, since these patients are using other drugs, drugs interactions should be considered.

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