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Yıl:2019; Cilt: 32; Sayı: 4>> Özet
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Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi; 2019;32(4):359-364
Duchenne müskuler distrofisi olgularında psikiyatrik eştanılar: Olgu serisi
U Ozer, AE Tufan
Acıbadem Üniversitesi, İstanbul
Duchenne muskuler distrofisi kalıtımsal multisistemik bir hastalıktır ve distrofin geninde mutasyonlar nedeniyle ortaya çıkmaktadır. Erken çocukluk döneminde proksimal kas güçsüzlüğü ile karakterize olan olgular genellikle 20 yaşından önce kaybedilmektedir. Duchenne muskuler distrofisi tanılı olgularda bilişsel ve nörodavranışsal değişiklikler sıklıkla gözlenmektedir. Ayrıca bu olgularda psikiyatrik bozukluklar da bildirilmiştir. Bu yazıda Duchenne muskuler distrofisi tanılı 12 olgu sunularak, bu olgularda görülen psikiyatrik eştanılara yer vermek, olguların anksiyete ve depresyon düzeyleri ile yaşam kalitelerini incelemek amaçlanmıştır. Hastanemizde yatarak tedavi gören DMD tanılı 12 olgu ile yaşlarına göre erişkin ya da çocuk ve ergen psikiyatristi tarafından görüşülmüştür. Psikiyatrik muayene ve detaylı tıbbi öykü ve psikiyatrik hastalık öykünün yanı sıra, Hastane Anksiyete ve Depresyon Ölçeği ve KINDL Ölçeği uygulanmıştır. Ayrıca aile görüşmesi de yapılmıştır. Olgulardan 5inde eştanılı psikiyatrik bozukluk saptanmış olup, eşlik eden tanılar depresyon, obsesif kompülsif bozukluk ve yaygın anksiyete bozukluğu olarak belirlenmiştir. İki olguda Hastane Anksiyete ve Depresyon Ölçeği doğrultusunda anksiyete düzeyleri eşik değerin üstünde saptanmıştır. Duchenne muskuler distrofisinde bilişsel ve nörodavranışsal değişikliklerin yanı sıra, olgularımızda olduğu gibi, depresyon, obsesif kompülsif bozukluk, yaygın anksiyete bozukluğu gibi psikiyatrik eştanılar gözlenmektedir. Aynı zamanda kronik hastalık süreci ve yetiyitimine bağlı olarak hem hastada hem ailesinde psikososyal destek ihtiyacı gündeme gelmektedir. Dolayısıyla psikiyatrinin bu olgularda bütüncül tedavi yaklaşımının bir parçası olması gerektiği ve ilk yıllardan itibaren psikiyatri desteği alınmasının önemi açığa çıkmaktadır.
Psychiatric comorbidities in cases with Duchenne muscular dystrophy: a case series
Duchenne muscular dystrophy is a hereditary multisystem disease caused by mutations in the dystrophin gene, characterized by proximal muscle weakness in early childhood, generally resulting in death before the age of 20 years. Cognitive and neurobehavioral changes are prevalent in Duchenne muscular dystrophy. Furthermore, psychiatric disorders have been reported. Here we present 12 cases with Duchenne muscular dystrophy, aiming to address psychiatric comorbidities and to examine anxiety and depression levels as well as the quality of life in these cases. Twelve inpatients with Duchenne muscular dystrophy were followed, according to their ages, by an adult psychiatrist or a child and adolescent psychiatrist. Psychiatric examination and detailed psychiatric and medical history-taking were performed. The Hospital Anxiety and Depression Scale (HADS) and the KINDL Questionnaire were administered and family interviews conducted. In 5 cases, comorbid psychiatric diagnoses were present, including depression, obsessive compulsive disorder, and generalized anxiety disorder. Anxiety levels according to the HADS were higher than threshold level in two cases. Alongside cognitive and neurobehavioral changes, psychiatric comorbidities such as depression, obsessive compulsive disorder, or generalized anxiety disorder might be seen in Duchenne muscular dystrophy, as was the case with our patients. At the same time, due to the chronic illness process and disability involved, psychosocial support is needed both for the patient and the family. Therefore, it is important that psychiatry should be part of a holistic treatment approach and that psychiatric support should be provided right from the first years in these cases.

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