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Yıl:2016; Cilt: 53; Sayı: 1>> Özet
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Nöropsikiyatri Arşivi; 2016;53(1):15-20
Alkol Bağımlısı Olan Hastalarda İçsel Farkındalığın Değerlendirilmesi
IA Çöl, MB Sönmez, ME Vardar
İnegöl Devlet Hastanesi, Bursa
Amaç: İçsel farkındalık (İF), bedensel sinyallerin dış uyaranlarla birlikte alınması, işlenmesi ve bütünleştirilmesini içeren içsel süreçleri doğru algılayabilme yetisi olarak tanımlanır. İçsel süreçler, uyaranlara karşı yaklaşma ya da kaçınma yönünde davranış motivasyonunu etkiler. Alkol ve diğer maddeler, otonomik sistem üzerinde içsel süreçlerde değişikliklerle sonuçlanan etkilere sahiptir. İçsel farkındalığı bozulmuş bireyler, karar mekanizmalarında bedensel sinyallerin yeterince değerlendirilememesi nedeniyle bağımlılık için daha fazla risk altında olabilirler. Bu çalışmada, alkol bağımlısı hastalarda İF’nin etkilenmiş olabileceği ve bozulmuş İF ile alkol aşermesi arasında ilişki olabileceği varsayımı test edildi. Yöntem: Ruhsal Bozuklukların Tanımlanması ve Sınıflandırması El Kitabı, Gözden Geçirilmiş Dördüncü Baskı (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; DSM-IV-TR) ölçütlerine göre alkol bağımlılığı tanısı konan ve iki haftadır ayık olan 55 hasta ile alkol bağımlısı olmayan 52 sağlıklı gönüllü çalışmaya alındı. İF ölçümleri, dört ayrı aşamada öznel olarak algılanan kalp atım sayılarının EKG ile kaydedilen gerçek sayılar ile karşılaştırılmasına dayanan ve katılımcıların kalp atımlarına karşı farkındalıklarını değerlendiren kalp atışı algı performansı yöntemi ile yapıldı. Ayrıca alkol bağımlıları grubuna Alkol Kullanım Bozukluklarını Tanıma Testi (AKBTT), Penn Alkol Aşerme Ölçeği (PAAÖ) ve Obsesif Kompülsif İçme Ölçeği (OKİÖ) uygulandı. Bulgular: Alkol bağımlısı hastalarda İF skorları kontrol grubuna göre anlamlı olarak düşüktü. Alkol bağımlılarının İF skorları ile PAAÖ sonuçlarına göre aşerme düzeyleri arasında ters yönde ilişki vardı. Sonuç: Sonuçlarımız, alkol bağımlısı hastalarda İF’nin etkilenmiş olabileceği, azalmış İF’nin alkol aşermesi ile ilişkili olabileceği ve içme davranışını sürdürmede etken olabileceği görüşünü desteklemektedir.
Evaluation of Interoceptive Awareness in Alcohol-Addicted Patients
Introduction: Interoceptive awareness (IA) is defined as an ability to accurately perceive interoceptive processes, which comprise receiving, processing, and integrating body-relevant signals together with external stimuli. Interoceptive processes affect the motivated approach or avoidance behavior toward stimuli. Alcohol and other substances have effects on the autonomic system that result in altered interoceptive processes. Individuals who have disturbed IA may be at a higher risk of addiction because they are not able to utilize sufficiently body-relevant signals to guide their decision-making. The hypothesis that IA in alcoholaddicted patients would be affected and that the disturbed IA would be associated with alcohol craving was tested in this study. Methods: The study was conducted with 55 patients diagnosed with alcohol addiction according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria and who had been sober for at least two weeks and 52 nonaddicted healthy controls. IA measurements were performed using the heartbeat perception performance method, which determines participants’ awareness of their own heartbeat by comparing the number of subjectively perceived heartbeats with an objective heart rate measure recorded with ECG during four separate intervals. In addition, the Alcohol Use Disorders Identification Test (AUDIT), Penn Alcohol Craving Scale (PACS), and Obsessive Compulsive Drinking Scale (OCDS) were performed on the alcohol-addicted patient group. Results: IA scores were significantly lower in the alcohol-addicted patients than the control subjects. IA scores of alcohol-addicted patients were negatively correlated with the levels of alcohol craving sensations according to the PACS results. Conclusion: Our results corroborate the suggestion that IA in alcoholaddicted patients would be affected and that poor IA would be associated with alcohol craving and could be a maintaining factor for drinking behavior

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