Dergi Ara >>
Yıl:2002; Cilt: 13; Sayı: 3>> Özet
TAM METİN
Türk Psikiyatri Dergisi; 2002;13(3):222-231
Tıbben açıklanamayan belirtiler
K Sayar
KTÜ Tıp Fak., Psikiyatri AD., Trabzon.
Bedensel belirtileri için tıbbi açıklama bulunamayan hastalar genel tıp uygulamasında yaygındırlar. Tıbben açıklanamayan belirtileri olan hastalar hem birincil hem de ikincil sağlık hizmeti hekimlerinde hayal kırıklığı yaratır ve bu hastalar, sağlık hizmetlerini aşırı kullanırlar. Hem sağlık ocaklarına hem de hastanelere çok sık gider ve aldıkları bakımdan memnun olmazlar. Tıbben açıklanamayan belirtileri olan hastalarda daha çok anksiyete ve depresyon olmak üzere yüksek oranda psikopatoloji görülür. Bu belirtiler kişilik patolojisi, çocukluk çağı zorlukları, erişkin çağı travması ve çocuklukta yaşanmış açıklanamamış tıbbi belirtilerle de ilişkilidir. Aleksitiminin bu belirtilerle ilişkisi ise tartışmalıdır. Bu belirtiler büyük oranda örtüşme gösterebilirler. Aynı kişi aynı anda bir kaç işlevsel somatik bozukluk tanı ölçütünü karşılayabilir. Klinisyen bedensel yaşantının toplumsal ve kültürel etkenler tarafından biçimlenebileceğinin de farkında olmalı ve hastayı belirtilerinin gerçekliği ve bedensel doğası hakkında bilgilendirmelidir. Aynı zamanda hastaya anlaşıldığını hissettirmeli ve onunla işbirliğine dayalı bir ilişki kurmalıdır ki hastalığıyla ilgili bazı yanlış düşüncelerini düzeltebilsin. Antidepresan tedavi ve bilişsel davranışçı psikoterapi açıklanamayan belirtileri olan hasta grubunda orta derecede etkili bulunmuştur. Ayrıca bu belirtiler bize Batı biyotıbbında uzun zamandır var olan zihin-beden ikiliği düşüncesini sorgulamakta yardımcı olabilir.
Medically Unexplained Symptoms
Patients with physical symptoms for which no medical explanation can be found are relatively common in general practice. Patients with medically unexplained symptoms are frequently frustrating to physicians both in primary and secondary care and utilize health sources disproportionately. They frequently attend both primary care units and hospitals and are usually not satisfied with the care they receive. Medically unexplained symptoms in patient populations are strongly associated with psychiatric pathology and with anxiety and depression in particular. They are also linked to personality pathology, childhood adversity, adult trauma or medically unexplained symptoms in childhood. The predictive value of alexithymia in determining these symptoms is controversial. Patients who have high negative affectivity or neuroticism tend to score high on measures of physical symptoms. These symptoms have a high degree of co-occurrence. The same person may meet the diagnostic criteria for several functional somatic syndromes simultaneously. The clinician should be aware of the cultural and social shaping of the bodily experience of these patients and hence acknowledge the somatic nature and reality of the symptoms. The clinician should make the person feel understood and establish a positive collaborative relationship. This would enable him/her to correct misconceptions about the disease and give a positive explanation of symptoms. Antidepressant therapy and cognitive-behavioural psychotherapy have been proved to be moderately effective in this group of patients. Because of the high disability that might be caused by these symptoms, psychiatrists and primary and secondary care physicians should pay careful attention to this clinical condition. These symptoms may also aid us in challenging the long-held idea of mind-body dualism which is inherent in Western biomedicine.

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