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Yıl:2016; Cilt: 6; Sayı: 4>> Özet
Psikiyatride Güncel; 2016;6(4):285-295
Erişkin dikkat eksikliği hiperaktivite bozukluğunun epidemiyolojisi ve etiyolojisi
Ö Kavakcı, Z Yelboğa
Cumhuriyet Üniversitesi, Sivas
Dikkat Eksikliği/Hiperaktivite Bozukluğu (DEHB) çocuklarda yaygın olarak tanı konulan ve erişkin yaşlarda da olguların önemli kısmında belirtilerin sürdüğü heterojen bir bozukluktur. DEHB için epidemiyolojik veriler, kullanılan yöntemlere göre değişmekle birlikte, çocuk ve ergenlerde bu bozukluğun %5.29 ve %7.1 oranlarında ve yetişkinlerde ise %2 ila 3.4 (%1.2-7.3) aralığında olduğu belirtilmektedir. Psikiyatriye başvuranlar arasında ve cezaevi popülasyonlarında genel toplum örnekleminden daha yüksek oranlarda olduğu bildirilmiştir. Çocuklar, ergenler ve erişkinlerde yaygınlık oranları yaş, cinsiyet, örneklemin alındığı yer, DEHB’nin klinik sunumu gibi bir dizi etkene bağlı olarak değişebilir. DEHB’nin etiyolojisi ile ilgili kesinleşmiş veri bulunmamakla birlikte, genetik etkenlerin bozukluğun gelişiminde önemli olduğu kabul edilmektedir. Dopamin taşınması (DAT1), dopamin reseptörleri (DRD4/DRD5) ile ilgili genler başta olmak üzere, serotonin sistemi (5HTT) ve sinaptik plastisiteyi belirleyen çeşitli genler (SNAP25) üzerinde durulmaktadır. DEHB olgularında beyin gelişmesinde gecikme ve aktivasyon bozuklukları gösterilmiştir. Bunun yanı sıra prenatal sigara, alkol, kurşuna maruz kalmak, erken doğum ve düşük doğum ağırlığı, travmatik beyin yaralanmaları, erken çocuklukta yoksunluk ve ihmalin DEHB etiyolojisinde etken olabileceği düşünülen durumlardır. Beslenme şekilleri, çeşitli gıdalar, gıda katkıları, koruyucular ve gıda boyaları ile DEHB arasında ilişki olduğunu ileri süren çalışmalar açık kanıt sağlayamamıştır. Erişkin DEHB’nin çocukluk DEHB’sinden farklı olabileceğini, erişkinlikte gözlenen olgularla çocuklukta tanı alan grubun tam olarak örtüşmediğini ileri süren araştırmalar da bulunmaktadır.
Epidemiology and etiology of adult attention deficit/hyperactivity disorder
Attention Deficit/Hyperactivity Disorder (ADHD) is a heterogeneous disorder which is widely diagnosed in children and whose symptoms continue also in a significant part of cases in adulthood. While the epidemiological data for ADHD varies according to the methods used, it is stated that the frequency of this disorder is between 5.29% and 7.1% in children and adolescents and between 2% and 3.4% (1.2-7.3%) in adults. It has been reported that it is seen at higher ratios among the ones attending the psychiatry clinics and in prison populations than the general population sample. The prevalence ratios may change depending on a variety of factors such as age, sex, place of sampling and clinic presentation of ADHD. While there is no clear data in relation to the etiology of ADHD, it is accepted that the genetic factors have an important role in the development of this disorder. The dopamine transporter gene (DAT1) and the genes related to dopamine receptors (DRD4/DRD5) being in the first place, the serotonin system (5HTT) and various genes determining the synaptic plasticity are being deliberated. In ADHD cases, delay in brain development and activation abnormalities have been presented. Besides, prenatal smoking, alcohol use, being exposed to lead, preterm birth and low birth weight, traumatic brain injuries, deprivation and neglect in early childhood are the cases which are thought to be a possible cause in the etiology of ADHD. The studies suggesting a relation between ADHD and diet types, various foods, food additives, preservatives and food colorings have not been able to provide a clear evidence. There are also researches claiming that the ADHD in adults may be different from ADHD in children and the cases observed in adults and the ones diagnosed in childhood do not fully overlap with each other.

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