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Yıl:2016; Cilt: 2; Sayı: 2>> Özet
Türkiye Klinikleri Çocuk Psikiyatrisi Özel Dergisi; 2016;2(2):53-58
Çocuk ve Ergende Nefrolojik ve Romatolojik Hastalıklarda Konsültasyon Liyezon Psikiyatrisi
OB Dursun, İS Esin, EY Demirdöğen
Atatürk Üniversitesi, Erzurum
Romatolojik ve nefrolojik hastalıklar, çocukluk çağında sık görülen, klinik bulgular açısından geniş bir dağılım sergileyebilen, çocukların yaşam kalitesini ve işlevselliğini önemli oranda etkileyen rahatsızlıklardır. Romatolojik hastalıklar inflamatuar romatolojik hastalıklar ve non inflamatuar bağ dokusu hastalıkları olmak üzere iki bölümde incelenebilir. Çocuk ergen ruh sağlığı perspektifinden bakıldığında İnflamatuar romatolojik hastalıklar daha çok immun sistem disfonksiyonu ile ilişkili olup, psikiyatrik hastalıklarla ortak etiyopatogeneze sahip olması ve sıklıkla bu hastalıklarla psikiyatrik komorbiditenin eşlik etmesi açısından önemlidir. İnflamatuar olmayan grup ise çocukluk dönemi tekrarlayan ağrılarının sık sebeplerinden olup, ağrı nedeniyle somatik belirti bozukluğu, konversiyon bozukluğu gibi psikiyatrik tanılar ile karışabilmesi açısından daha çok ayırıcı tanıda daha önemlidir. Çocukluk çağı nefrolojik hastalıklarında da birçok psikiyatrik bozukluk eş tanı olarak görülmektedir. Bu eş tanıların bir kısmı kronik hastalığın sonucu olarak değerlendirilirken, bir kısmı da mevcut hastalık için kullanılan tedavilere bağlı gelişebilen depresyon, anksiyete, uyku bozuklukları, bilişsel bozukluklar gibi psikiyatrik bozuklukları kapsar. Ayrıca bu alanda en sık zorluk yaşanan durumlardan biri böbrek yetmezliği durumunda psikotropik ilaç kullanımının düzenlenmesidir. Böbrek yetmezliği ilaç farmakokinetiğini farklı yollarla etkileyebildiğinden, bu durumda doz ayarlanmasına ihtiyaç duyulan ilaçlarla ilgili bilgi sahibi olunmalıdır. Hem romatoloji hem nefroloji alanında, ayırıcı tanı yapılabilmesi, komorbid psikiyatrik bozukluğun tespit edilerek tedavi edilebilmesi, ilaç yan etkilerinin değerlendirilmesi ve yönetiminin yapılabilmesi açısından multidisipliner bir yaklaşıma ihtiyaç duyulmaktadır.
Consultation Liaison Psychiatry in Chilhood and Adolescent with Nephrologic and Rheumatologic Diseases
Rheumatologic and nephrologic disease which are common in childhood, can ocur with a wide range of presentations and can significantly affect children's quality of life and functionality. Rheumatic diseases, can be examined under two main groups, namely inflammatory and non-inflammotory musculoskeletal diseases. Inflammatory rheumatic diseases, mostly associated with immune system dysfunction are important with regards to shared identic aetiopathogenesis and be accompanied by comorbidity psychiatricconditions. non-inflammotory musculoskeletal diseases are among the most common causes of recurrent pain in childhood, and differential diagnoses with psychiatric diagnoses such as somatic symptom disorders and conversion disorder can be confussing for clinicians. Psychiatric comorbidy is also a common entity of childhood nephrologic diseases. Some of these comorbid diseases can ocur either as a result of chronic disease, or related with drugs used in the treatment of renal diseases. On the other hand one of the most common difficulties that clinicians face in this area is the psychotropic drug usage in case of renal failure. Because of the fact that renal failure can affect pharmacokinetics of drugs in different ways, clinicians should have adequate information about drugs which requires dose adjustment. Both in rheumatology and nephrology fields, multidisciplinary approach is essential for differential diagnosis, determination and treatment of comorbid psychiatric disorders and and management of side effects.

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