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Yıl:2007; Cilt: 44; Sayı: 1>> Özet
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Nöropsikiyatri Arşivi; 2007;44(1):1-9
Ankilozan Spondilit Hastalarında Psikiyatrik Belirtilerin Yetiyitimi ve Yaşam Kalitesi ile İlişkileri
İ Eren, M Şahin, E Cüre, İÇ İnanlı, ŞE Tunç, A Küçük
Süleyman Demirel Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, Isparta
Amaç: Ankilozan spondilit (AS), nedeni bilinmeyen, kronik, sistemik, inflamatuar bir hastalıktır. Hastanın günlük fonksiyonlarını bozarak, yorgunluğa ve psiko­lojik bozukluklara sebep olarak, ciddi sakatlığa yol açabilmektedir. Bu çalışma­mızda AS hastalarının psikiyatrik semptomları ve yaşam kalitesi ile psikiyatrik belirtilerin yaşam kalitesine etkisini değerlendirmeyi amaçladık. Yöntem: Çalışmaya 11 kadın, 27 erkekten oluşan toplam 38 AS'Iİ hasta ve 38 sağ­lıklı kontrol bireyi alındı. Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BAS-DAI), Beck Depresyon Ölçeği (BDÖ), Beck Anksiyete Ölçeği (BAÖ) ve Kısa Semptom Envanteri (KSE), Kısa Yeti Yitimi Anketi (KYA), Kısa Form 36 (SF-36) formları her iki gruba da uygulandı.
Bulgular: AS hastalarının KSE somatizasyon, kişiler arası duyarlılık, anksiyete, hostilite, fobik anksiyete ve rahatsızlık ciddiyeti indeksi (RCİ) puanları kontrol grubundan anlamlı olarak yüksek bulundu. Hasta grubunda BAÖ ve BDÖ puan­ları da anlamlı olarak daha yüksekti. Eritrosit sedimentasyon hızı (ESH) ve serum C-reaktif protein (CRP) değerleri ile BDÖ ve BAÖ puanları arasında anlamlı po­zitif ilişki bulundu. Hastalarda SF-36 fiziksel fonksiyon, fiziksel rol güçlüğü, emosyonel rol güçlüğü, ağrı, enerji ve genel sağlık algısı alan puanları anlamlı olarak daha düşük bulundu. Ayrıca KYA toplam puanı hasta grubunda kontrol grubundan anlamlı olarak yüksek bulundu. Hasta grubunda BASDAI puanı ve ESH ile enerji ve mental sağlık alan puanların, CRP ile fiziksel fonksiyon, fiziksel rol güçlüğü, enerji, sosyal fonksiyon, mental sağlık ve sağlığın genel algılanma­sı alan puanlarının anlamlı negatif, buna karşın CRP ile KYA toplam puanının an­lamlı pozitif ilişkilerinin olduğu saptandı.
Sonuç: AS hastalarında depresyon ve anksiyete başta olmak üzere psikiyatrik belirtiler yaygın olarak bulunmaktadır. Yine bu hastalarda yetiyitimi ile birlikte yaşam kalitesinde de belirgin düşüklük görülmektedir. Yaşam kalitesi ve yetiyi­timi, depresyon ve anksiyete düzeyleri ile ilişkilidir. Kronik bir hastalık olan AS'lı hastalarda hastalığın güncel tedavisine ek olarak psikiyatrik semptomlara yak­laşım ve destek hastaların yaşam kalitesinin arttırılmasına katkı sağlayacaktır.
Interactions Between Psychiatric Symptoms and Disability and Quality of Life in Ankylosing Spondylitis Patient
Objective: Ankylosing spondylitis (AS) is a chronic, systemic, and inflammatory disease which has unknown etiology. It may cause serious handicaps as it dis­rupts daily functions of patients, causes fatigue and psychiatric disorders. In this study, we aimed to assess psychiatric symptoms and quality of life in AS patients, and effects of psychiatric symptoms on the quality of life. Method: The study included 38 AS patients (11 female and 27 male), and 38 he­althy volunteers. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI), Brief Symptom Inventory (BSI), Brief Disability Questionnaire (BDQ), and Short Form-36 (SF-36) were administered for both groups. Results: The subscales of BSI such as somatization, interpersonal sensitivity, anxiety, hostility, phobic anxiety and global severity index scores of AS patients were significantly higher than scores of the control group. BDI and BAI scores were also significantly higher in the patient group than scores of the control group. A significantly positive relationship was determined between BASDAI scores and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values. SF-36 physical function, role limitation due to physical health and emo­tional health, bodily pain, energy/vitality and general health perception domain scores were significantly lower in the patient group than the control group. BDQ total scores were also significantly higher in AS patients than the control group. In the patient group, significant negative correlations were found betwe­en BASDAI score, ESR and energy-vitality, mental health domain scores. Signi­ficant negative correlations were also found between CRP and physical functi­oning, role limitations due to physical health, energy/vitality, social function, mental health and general health perception domain scores while a significant positive correlation was found between CRP and BDQ total scores Conclusion: Psychiatric symptoms, especially depression and anxiety, are wi­dely seen in patients with AS. Decrease in quality of life and disability are also seen in these patients. Quality of life and disability are correlated with depres­sion and anxiety levels. Therefore, in addition to the recent management of AS, psychiatric symptoms such as depressed mood and anxiety should also be ta­ken into consideration in order to increase the quality of life in AS patients.

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