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Yıl:2015; Cilt: 18; Sayı: 3>> Özet
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Klinik Psikiyatri Dergisi; 2015;18(3):107-110
Diabetes Mellitus Tanılı Hastada Akut Başlangıçlı Psikiyatrik Bulgular
BÇ Arı, B Özdilek, G Kenangil, FM Domaç
Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul
Diabetes Mellitus hiperglisemi nedeniyle birçok organ sistemlerinde metabolik bozukluklara yol açan endokrinolojik bir hastalıktır. Diabetes Mellitus’a bağlı ortaya çıkan nöropsikiyatrik komplikasyonlar ise deliryum, psikoz, depresyon, öfke kontrol kaybı, panik bozukluk, obsesif-kompulsif bozukluk, fobiler, cinsel işlev bozukluğu, yeme bozuklukları, alkol veya ilaç bağımlılığı, otonomik nöropati, motor veya somatosensorial mono veya polinöropati ve kore – ballismus gibi hiperkinetik hareket bozukluklarıdır. Hipergliseminin bazal gangliyonlarda fokal hasarlanma yaparak serebral kan akımını azalttığı, bu bölgelerdeki GABA miktarında azalmaya yol açtığı ve sonrasında nöronal disfonksiyona yol açarak nöropsikiyatrik bulguların ortaya çıkmasına neden olduğu gözlenmiştir. Sıkı bir glisemik kontrol sonrası bazı nöropsikiyatrik bulgularda kısmi de olsa düzelme olabileceği tespit edilmiştir. Bu olguda, akut olarak yeni başlayan psikiyatrik bulgularla psikiyatri kliniğine sevk edilmiş ve kontrol altında olmayan Diabetes Mellitus tanısı olan, nörogörüntülemelerinde ise bilateral bazal gangliyonlarda lezyon saptanan bir hastayı sunmayı amaçladık.
Acute Onset Psychiatric Symptoms in Diabetic Patient: A Case Report
Diabetes Mellitus is an endocrinologic disease that causes multiple organ failures due to hyperglycemia. The neuropsychiatric complications occurring along with diabetes are delirium, psychosis, depression, loss of control, panic disorder, obsessive - compulsive disorder, phobias, sexual problems, eating disorders, alcohol or drug dependence, autonomic neuropathy, sensorimotor mono or polyneuropathy and hyperkinetic movement disorders such as chorea – ballismus. It has been observed that hyperglycemia decreases cerebral blood flow by causing focal damage in basal ganglia and deficiency in GABA levels and conclusively presenting neuropsychiatric symptoms thorough neuronal dysfunction. If glycemic control is enough well, a partial improvement of some neuropsychiatric symptoms can be achieved. In this case report, we aimed to submit a patient who is referred to psychiatry clinic with newly onset psychogenic symptoms and uncontrolled diabetes with basal ganglia lesions in neuroimaging.

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