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Yıl:2020; Cilt: 21; Sayı: 2>> Özet
TAM METİN
Anadolu Psikiyatri Dergisi; 2020;21(2):211-217
DEHB tanılı Türk çocuk ve ergenlerde metilfenidatın ağırlık, boy ve beden kitle indeksi üzerine etkisi
S Turan, AP Akay
Ödemiş Devlet Hastanesi , İzmir
Amaç: Psikostimülan (metilfenidat) tedavisinin büyüme üzerindeki etkilerinin altında yatan patofizyolojik mekanizmalar hala tartışmalıdır. Dikkat eksikliği hiperaktivite bozukluğu (DEHB) olan Türk çocuklarında ve ergenlerinde metilfenidatın boy, kilo ve beden kitle indeksi (BKİ) üzerindeki uzun dönem etkilerinin araştırılması planlanmıştır. Yöntem: Dokuz Eylül Üniversitesi Tıp Fakültesi Çocuk ve Ergen Psikiyatrisi Anabilim Dalı'nda en az 1 yıl boyunca metilfenidat tedavi edilmiş DEHB’li katılımcılar (6-18 yaş, 330 erkek, 103 kız) geriye dönük taranarak çalışmaya alınmıştır. Tedaviye başlamadan önce ve izleme sürecinde ağırlık, boy ve BKİ değerleri, Türk toplum normları kullanarak yaşa ve cinsiyete göre düzeltilmiş z puanlarına dönüştürülmüştür. Bulgular: Boy ve ağırlık z standart sapma puanlarının (SDS) tedavi ile azaldığı saptandı (başlangıç boy-SDS [SDS]: 0.74±1.43, izlem boy-SDS [SDS]: -0.67±4.35, t-testi p<0.001; başlangıç ağırlık-SDS [SDS]: 0.61±1.28 ve izlem-ağırlık-SDS [SDS]: -0.41±0.76, t-testi p<0.001). Metilfenidat tedavisinden önce ve sonra BKİ-SDS'de anlamlı düzeyde farklılık saptanmadı (başlangıç BKİ-SDS [SDS]: 0.27±1.21, izlem BKİ-SDS [SDS]: -0.20±4.54, t-testi p=0.353). Ancak, ilaç tedavisine başlandığı sırada olguların çocuk (6-12 yaş) veya ergen (13-18 yaş) olup olmadığına bakıldığında, çocuk grubunda boy ve BKİ tedaviden etkilendiği bulundu (başlangıç boy-SDS [SDS]: 0.87±1.42; izlem boy-SDS [SDS]: -0.78±4.81; p=0.002; (başlangıç BKİ-SDS [SDS]: 0.29±1.19; izleme BKİ-SDS [SDS]: -0.21±0.69; p<0.001). Farklı etkenlerin, tedaviye olası katkısını değerlendiren çoklu lineer regresyon analizinin sonuçları, sadece tedaviye başlangıç yaşının (B=- 0.039, p=0.011) son ağırlığı öngördüğünü saptadı. Tartışma: Metilfenidatın boy ve BKİ üzerine olumsuz bir etkisinin olduğu sonucuna varılmıştır. Çalışmadan elde edilen bulguların DEHB'nin seyrini etkileyebilecek büyüme parametrelerinin değerlendirilmesinde, daha etkin ve kalıcı tedavi yaklaşımlarının oluşturulmasında ve hastaların tedaviye uyumunun sağlanmasında yardımcı olabileceği düşünülmektedir. (Anadolu Psikiyatri Derg 2020; 21(2):211-217)
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