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Yıl:2016; Cilt: 6; Sayı: 4>> Özet
TAM METİN
Journal of Mood Disorders; 2016;6(4):189-195
Adet döngüsü iki uçlu bozukluklu hastaları mı unipolar depresyonlu hastaları mı daha çok etkiler?
MF Yılmaz, AD Başterzi, E Özsin, ŞT Acar, AE Yazıcı, K Yazıcı
Erdemli Devlet Hastanesi, Mersin
Amaç: Adet öncesi yakınmalar üreme çağındaki kadınların çoğunda görülmektedir. Bu yakınmalar kadınların yalnızca ruhsal ve işlevsellik açısından değil ikili ilişkilerde de sorun yaşanmasına neden olmaktadır. Duygudurum bozukluklarıyla adet öncesi ruhsal yakınmalar arasındaki ilişki daha çetrefillidir. DSM-5’te depresif bozukluklar altında sınıflanan premenstrüel disfori sendromunun duygudurum bozukluklarıyla eştanılı olarak görülebildiği ya da adet öncesi dönemde mevcut duygudurum bozukluğunda şiddetlenme görülebildiği öne sürülmektedir. Duygudurum epizodlarının aktif olduğu dönem dışında duygudurum bozukluğu olan kişiler adet öncesi dönemle ilgili nasıl sorunlar yaşamaktadır? Belirtilerde şiddetlenme ya da premenstrüel disfori sendromu görülme sıklığı sağlıklı kişilerden farklılık göstermekte midir? Bu araştırmada bu sorulara yanıt aranmıştır. Yöntem: Mersin Üniversitesi Araştırma ve Uygulama Hastanesi Psikiyatri Polikliniğinde takip edilen en az 6 aydır ötimik 23 iki uçlu bozukluk, en az 6 aydır remisyonda 23 majör depresif bozukluk ve 23 sağlıklı gönüllü kadın çalışmaya alınmış, sosyodemografik veriler, hastalık seyir özellikleri kaydedilmiş ve Adet Öncesi Değerlendirme Formu (AÖDF) uygulanmıştır. Verilerin değerlendirilmesinde SPSS 11.5 paket programıyla ki kare, z testi, ANOVA ve ikişerli karşılaştırılmasında Tukey HSD kullanılmıştır. Bulgular: Premenstrüel Sendrom (PMS), depresyon grubunda kontrol grubuna göre daha sık görülmüştür. İki uçlu bozukluk grubunda ise sağlıklı kontrol grubuna benzer oranlarda görülmüştür. AÖDF’undaki çökkün duygudurum, histerik özellikler, düşmanlık/ kızgınlık, impulsivite, organik mental özellikler, çeşitli duygudurum/ davranış değişiklikleri alt ölçekleri puanları ve toplam puan depresyon grubunda kontrol grubuna göre yüksek bulunmuştur (p=0.022). İki uçlu bozukluk hastalarının klinik seyrine bakıldığında ötimik olarak geçen süre uzadıkça PMS şiddetinin azaldığı bulunmuştur. Tartışma: Adet öncesi yakınmalar tedavi altında olsa bile depresif hastalarda daha şiddetli görünmektedir. İki uçlu bozukluk hastalarında çalışma öncesi beklenildiği gibi adet öncesi belirtilerde şiddetlenme görülmemiştir. Bunun nedeni iki uçlu bozuklukta düzenli tedavi ile beyindeki birçok nörobiyolojik etkileşim olabilir. Bu ilişkiyi anlayabilmek için daha fazla çalış- maya ihtiyaç duyulmaktadır.
Does menstrual cycle affect bipolar disorder patients or unipolar depression patients more?
Objective: Premenstrual symptoms are seen in most of the women in reproductive age. These symptoms not only effect women’s mental state and functionality but also their personal relations. The relationship between premenstrual symptoms and mood disorders are quite complex. In DSM-5, Premenstrual Dysphoric Syndrome is classified under depressive disorders and it is suggested as a comorbidity with mood disorders or exacerbation of current mood disorder. Apart from the active episodes, what kind of problems do patients with mood disorders experience? Is exacerbation of symptoms or an increase in frequency of premenstrual dysphoric syndrome seen more compared to healthy controls is? In this present study, we tried to find answers for these questions. Methods: Women with bipolar euthymic (n=23) or major depressive disorder in remission (n=23) who were registered at Mersin University Research and Practice Hospital Psychiatry Outpatient Clinic of were included in this study, as well as 23 healthy control women. Sociodemographic data and clinical features regarding the course of the disorders were noted. All subjects were administered Premenstrual Assessment Form. Statistical analyses were performed with SPSS 11.5 and Chi Square, z test, ANOVA and Tukey HSD were used. Findings: Premenstrual syndrome (PMS) was more frequent in the major depression group than the control group while its frequency in the bipolar group was similar to the control group. In the premenstrual assessment form; depressive mood/ loss of pleasure, hysteric features, hostility/ anger, impulsivity, organic mental features subscale scores, and the total score were higher in the depression group than the control group (p=0.022). Regarding the bipolar patients, we found that the longer the duration of euthymic phase the lesser were the severity of PMS. Conclusion: Premenstrual symptoms seem to be more severe in depressed patients even they are under treatment. We did not see any worsening of premenstrual symptoms in bipolar patients as we hypothesized initially. The reason might be the underlying neurobiological interactions in the brain with appropriate bipolar treatment. More studies are needed to understand the nature of this relationship.

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