Dergi Ara >>
Yıl:2006; Cilt: 2; Sayı: 12>> Özet
Türkiye Klinikleri Dahili Tıp Bilimleri Dergisi Psikiyatri; 2006;2(12):21-25
Panik Bozukluk: Etiyoloji, Klinik Gidiş, Komorbidite ve Tedavisi
Ş Uğuz, EY Altıntaş, BA Levent
Çukurova Üniversitesi Tıp Fakültesi Psikiyatri ABD, ADANA
Panik atak ani başlangıçlı anksiyetenin fiziksel belirtilerinin eşlik ettiği yoğun bir korku halidir. Panik atakta görülen belirtiler; çarpıntı, taşikardi, terleme, titreme, nefes darlığı, göğüs ağrısı, bulantı, derealizasyon, depersonalizasyon, kontrolünü kaybetme, delirme, öleceği korkusu, uyuşma ve sıcak basmalarıdır. İlk atak genellikle aniden başlamaktadır. Bazı hastalarda ataklar arasında "beklenti anksiyetesi" denen bir anksiyete gelişmektedir. Panik bozukluğun esas özelliği tekrarlayan panik ataklardır. Panik bozukluğun yaşam boyu yaygınlığı %1.4 ile %3.8 arasındadır. Tipik başlangıç 20'li yaşlardır. Kadınlarda erkeklere göre daha fazla görülmektedir. Dul, boşanmış, ayrı yaşayanlar ve büyük şehirde oturanlarda panik bozukluk görülme riski daha fazla olmaktadır. En sık rastlanan komorbid durum, kaçmanın güç olacağı yerlerden korku duymak anlamına gelen agorafobidir. Diğer psikiyatrik bozuklukların (agorafobi, depresyon, diğer anksiyete bozuklukları, alkol bağımlılığı) eşlik etmesi yaşam kalitesini bozmakta ve sosyal yaşamı olumsuz olarak etkilemektedir. Panik bozukluğun tedavisinde, seçici serotonin geri alım inhibitörleri, trisiklik antidepresanlar, benzodiazepinler, betablokerler ve kognitif davranışçı psikoterapiler kullanılmaktadır. Seçici serotonin geri alım inhibitörlerinin tolerabilitesi oldukça iyiyken, trisiklik antidepresanlara uyum daha zor olmaktadır. Benzodiazepinlerin bağımlılık problemi kullanımlarını sınırlandırmaktadır. Yapılan çalışmalar her iki grup tedavininde kısa dönemde etkili olduğunu bildirmektedir. Ancak ilaç tedavisi ile psikoterapinin kombinasyonu tek başlarına kullanımlarına göre daha iyi yanıtlar verebilmektedir.
Panic Disorder: Etiology, Clinical Course, Comorbidity And Treatment
Panic attack is a sudden, intense feeling of fear with physical symptoms of anxiety. The symptoms of panic attacks are palpitations, tachycardia, sweating, trembling, shortness of breath, chest pain, nausea, derealization or depersonalization, fear of losing control or going mad, fear of dying, paraesthesia, and hot flushes. The first attack usually begins spontaneously. Some patients develop anxiety between panic attacks that is called 'anticipatory anxiety'. The recurrent panic attacks is the main feature of the panic disorder. The lifetime prevelance of the panic disorder is between 1.4% and 3.8%. The typical onset is in 20s. More common in women than in men. Widowed, divorced, or separated individuals and people living in the big cities have greater risk of panic disorder. The most comorbid condition to the panic disorder is agoraphobia, which means the fear of places from where escape might be difficult. The comorbidity of other psychiatric disorders (agoraphobia, depression, other anxiety disorders, alcoholism) decrease the quality of the life and impairs the social life. The treatments of the panic disorder includes pharmacotherapy such as selective serotonin reuptake inhibitors, tricyclic antidepressants, benzodiazepines, beta blockers and cognitive behaviour therapy. Selective serotonin reuptake inhibitors has a good tolerability. But the tricyclics are often poorly tolerated. The dependency potential of the benzodiazepines, limits their usefulness. The studies suggest that both treatments are effective in the short term. But the combination of psychological and pharmacological treatments may be better than only psychological or pharmacological treatments.

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