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Yıl:2006; Cilt: 2; Sayı: 47>> Özet
Türkiye Klinikleri Dahili Tıp Bilimleri Dergisi Psikiyatri; 2006;2(47):64-69
Kronik Karaciğer Hastalıkları ve Psikiyatri
B Duman, A Yılmaz, A Soykan, H Kumbasar
Ankara Üniversitesi Tıp Fakültesi Psikiyatri AD, ANKARA
Bedensel hastalıklarla, psikiyatrik hastalıkların ilişkisi çok karmaşık ve boyutludur. Bedensel hastalık ve psikiyatrik hastalıkların bulguları birbirine benzemektedir ve biri diğerinin bulgularını maskeleyebilir. Bu hastalıklar, birbirlerinin sonuçlarını da etkileyebilmekte, bulgulardan birini azaltmaya yönelik tedavi diğerinin bulgularını artırabilmektedir. Psikiyatrik hastalıkların uygun tedavisi, komorbid fiziksel hastalığın seyrine olumlu etkide bulunabilirken, hastanın yaşam kalitesini de arttırabilmektedir. Karaciğer hastalıklarında görülebilecek psikiyatrik tablolar, karaciğerin patolojisine yönelik kullanılan ilaç tedavilerinin yan etkileri ve bozulmuş karaciğer fonksiyonları ile değişen ilaç metabolizması nedeni ile karaciğer hastalarının ayrıntılı değerlendirilmesi önemlidir. Hepatit B, hepatit C toplumda en sık görülen karaciğer hastalıklarıdır. Genel olarak, HCV infeksiyonunun hem karaciğer dışı görünümleriyle, hem de santral etkileriyle HBV’ye kıyasla daha fazla psikiyatrik bulgu gösterdiğine inanılsa da, HBV infeksiyonunun HCV’ye benzer hasta gruplarında görülmesi ve dünya üzerindeki yaygınlığı nedeniyle psikiyatrik bulguları ve sonuçları açısından dikkatli olunmalıdır. Tedavilerinde kullanılan INF tedavisi alacak bütün hastaların ise başta depresyon olmak üzere psikopatoloji gelişimi açısından dikkatlice değerlendirilmesinin öneminin yanı sıra gastroenteroloji uzmanları tarafından uygulanacak bazı ölçeklerin kullanılması ile hangi hastaların daha kapsamlı bir psikiyatrik değerlendirmeye başvurması gerekliliği de erken farkedilebilir. Gelişen psikopatolojiye yönelik tedavi düzenlerken psikotrop ilaçlar ile birlikte bedensel hastalıklar için kullanılmakta olan ilaçların etkileşimi, psikotrop ilaçların var olan bedensel hastalıkların bulgularını arttırabileceği ve bozulmuş organ fonksiyonları üzerine olan etkileri göz önünde bulundurmalı ve uygun tedavi seçeneği tercih edilmelidir.

Chronic Liver Disease and Psychiatry
The interaction between psychiatric diseases and somatic diseases are multidimensional and complicated. Symptoms of somatic and psychiatric diseases are similiar and one masks each other. Also, this diseases acts the outcomes of each other and the therapy which aims the reduction in symptoms also cause the others symptoms aggravates. The favourable therapy of psychiatric disease improves the pattern of the comorbid somatic disease and increases the patients’ life quality. Psychiatric conditions, adverse affects of drug therapy which is used in liver disease and altered hepatic functions which causes changed drug metabolism triggers the exact examination of the patients which have liver disease important. Hepatitis B and Hepatitis C are the most common liver diseases in the population. Generally, however it is believed that rather than Hepatitis B infection Hepatitis C infection is with both extrahepatic and central effects triggers psychiatric symptoms, HBV inf. is seen in the similiar patient population with HCV inf. and because of the worldwide penetration it needs to be attention. Examination needs attention first depression to the development of psychopathology of all patients who will take INF therapy, which is used in their therapy, as well as use of some scales by gastroenterologists causes the early awareness of the need of psychiatric examination. When ordering the drugs for the psychopathology; it needs to consider the drug interaction with psychotropic drug and the drug which is used for the somatic disease, also the probability of the psychotropic drugs aggravation potential of the somatic disease symptoms and also effect of the altered organ and the best therapy option must be chosen.

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