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Yıl:2008; Cilt: 45; Sayı: Özel>> Özet
TAM METİN
Nöropsikiyatri Arşivi; 2008;45(Özel):37-43
Multipl Skleroz ve Tedavisindeki Gelişmelerin Psikiyatrik Yönü
AK Tihan
İstanbul Üniv. İstanbul Tıp Fak. Psikiyatri ABD, İstanbul
Multipl skleroz (MS), santral sinir sisteminde (SSS) beyaz maddedeki multifokal lezyonlarla giden, pek çok nöropsikiyatrik semptomla karakterize, kronik gidişli demyelinizan bir hastalıktır. MS, sinir hücrelerinin myelin kılıfını tutarak aksiyon potansiyelinin iletimini bozar. Bunun sonucunda pek çok nörolojik semptom ve neticede yeti yitimi ortaya çıkar. Psikiyatrik bozukluk ve semptomlar hastalık süreci boyunca birincil ya da ikincil nedenlerle tabloya eşlik eder. En çok depresyon olmak üzere duygudurum bozuklukları, diğer psikiyatrik bozukluklar, yorgunluk ve bilişsel bozulma hastanın yaşam kalitesini daha da düşürmektedir. Klinik tablo ise nörolojik belirtilerle bilişsel ve davranışsal belirtilerin içice geçmesiyle daha da karmaşıklasın MS psikiyatrik belirtilerle de başlayabilmektedir. Plakların yerleşimine ve yaygınlığına bağlı olarak çeşitli davranış ve duygulanım değişiklikleri görülebilir. Hastalık algısı ve kişinin başa çıkma stratejileri de yaşam kalitesini, dolayısıyla prognozu etkileyebilir. Tedavisinde de çokça psikiyatrik yan etkileri olan kortikosteroidler, immün süpresif ajanlar gibi ilaçlar kullanılmaktadır. MS hastalarının takibinde çok yönlü ve kapsamlı bir yaklaşım uygulanması gerekli görünmektedir. Bu gözden geçirme yazısında; multipl skleroz hastalığının seyrinde ortaya çıkabilecek psikiyatrik bozuklukların ve semptomların, ayrıca bunların klinik gidiş, prognoz, hasta işlevselliği ve yaşam kalitesi üzerindeki muhtemel etkilerinin güncel literatür ışığında değerlendirilmesi amaçlandı.
Psychiatric Aspects of Multiple Sclerosis and Recent Treatment Approaches
Multiple sclerosis (MS) is a chronic demyelinating disorder characterized by multiple neuropsychiatrie symptoms related to multifocal lesions in the white matter of the central nervous system (CNS). MS disrupt the conductance of action potential by effecting myelin coats of the neurons. Thus, many neurological symptoms and consequently disability may occur. Psychiatric disorders and symptoms accompanies in the course of MS as primary or secondary reasons. Mood disorders; especially depression, psychiatric disorders, chronic fatigue and cognitive impairment decrease the patient's quality of life. Clinical course become more complicated because of the neurological, cognitive and psychiatric symptoms co-occurrence. Multipl behavioral and affective alterations may arise due to location and extension of the plaques. Illness perception and the coping strategies may also effect life quality and consequently the prognosis. The treatment of MS includes corticosteroids and the immunosuppressive agents which have various psychiatric side effects. So management of MS patients requires a multidisciplinary and comprehensive approach. The purpose of this rewiev is the evaluation of psychiatric disorders and symptoms due to MS and its treatment and also their possible effects on clinical process, prognosis, patient's compatibility, life quality depending on the actual literature.

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