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Yıl:1998; Cilt: 9; Sayı: 1>> Özet
Türk Psikiyatri Dergisi; 1998;9(1):1-12
Konversiyon Bozukluklarında Olaya Bağlı İşitsel Uyarılmış Potansiyeller (P300): Depresyon ve Anksiyete ile İlişkileri
S KÖSE, Z TUNCA, R ÇAKMUR, F İDİMAN, C FİDANER
Konversiyon bozukluklarının ruhsal hastalıkların sınıflandırılmasındaki yeri tartışmalıdır. Ülkemizde sık rastlanan bu bozukluğun nörofizyolojik doğası da tam olarak bilinmemektedir. Bu çalışmada konversiyon bozukluğu-bayılma belirtili (n=22), 11 konversiyon bozukluğu-nörolojik belirtili (n=11) ve kontrol (n=19) denekleri olmak üzere üç grubun olaya bağlı işitsel uyarılmış potansiyelleri standart oddball paradigması (şaşırtmalı uyaran dizisi) kullanılarak elde edildi. İşlem öncesinde tüm deneklere depresyon ve anksiyete ölçekleri uygulandı. Bayılma belirtili grubun P1, N1, P2, N2, P3 latansları kontrol grubuna göre uzamış bulundu. Bayılma belirtili grubun, bilgi işlemlemenin erken ve geç süreçlerinde yetersizlik gösterdikleri düşünüldü. Diğer nörolojik belirtili grubun N1 ve P2 latansları kontrol grubuna göre uzamış bulundu. P3Fz amplitüdü diğer nörolojik belirtili grupta anlamlı olarak azalmış bulundu. Diğer nörolojik belirtili grubun endojen somatik belirtileri anlama ve uyaranları filtrelemede yetersizlik gösterdikleri düşünüldü. Hamilton Depresyon Değerlendirme Ölçeği, Hamilton Anksiyete Ölçeği, Durumsal/Sürekli Anksiyete Envanteri puanları ile olaya bağlı uyarılmış potansiyellerin latans ve amplitüdleri arasında ilişki saptandı. Konversiyon bozukluklarının oluşumunda limbik sistem, paralimbik yapılar, lokus seruleus ve frontal lob yapılarının önemli rol oynayabileceği düşünüldü. Literatür bulguları ışığında, konversiyon bozukluklarının nörofizyolojik açıdan anksiyete bozukluklarına benzerlik gösterdikleri sonucuna varıldı.


Event-related Auditory Potentials (P300) in Conversion Disorders: Correlations with Rating Scales for Depression and Anxiety
Event-related potentials (ERP), especially their endogenous components are of particular interest in psychiatric disorders. This study attempted to investigate the event-related potentials in 22 patients with conversion disorder-pseudoseizure type and 11 patients with conversion disorder-pseudo-neurologic type, comparing with 19 age-and sexmatched healthy controls. ERPs were elicited by using the standard auditory oddball paradigm and recorded according to the 10-20 system from Fz, Cz and Pz midline placements and with linked ears reference. Preceding an auditory ERP, subjects were applied the Hamilton Rating Scale for Depression, Hamilton Anxiety Scale and the Spielberger’s State-Trait Anxiety Scale and the Spielberger’s State-Trait Anxiety Inventory. P1, N1, P2, N2, and P3 latencies were observed to be significantly prolonged in pseudoseizure group than the controls. N1 and P2 latencies were also found to be substantially prolonged in pseudoneurologic group than the controls. Another important finding was that P3Fz amplitude was considerably reduced in pseudoneurologic group than the controls. Correlations were found between the ERP latencies and amplitudes and the Hamilton Rating Scale for Depression, the Hamilton Anxiety Scale for Depression, the Hamilton Anxiety Scale and the Spielberger’s State-Trait Anxiety Inventory. Within this framework; all these results might suggest that patients in pseudoseizure group display higher level of arousal and more superficial attention in both earlier and later stages of information processing. Another emphasis should be laid on the finding that patients in pseudoneurologic group might have a disturbance in stimulus filtering and a defect in understanding endogenous somatic signals. In conclusion, it can be stated that these findings might indicate importance of limbic system, locus coeruleus, mesial frontal lobes in pathogenesis of conversion disorders.

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