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Yıl:2008; Cilt: 18; Sayı: 4>> Özet
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Klinik Psikofarmakoloji Bülteni; 2008;18(4):309-312
Büyüsel düşüncenin eşlik ettiği frontal lob sendromu: Olgu sunumu
N Cansel, F Yalçın, HA Savaş, A Özovacı, S Selek
Gaziantep Üniversitesi Tıp Fakültesi, Gaziantep-Türkiye
İnsan beyni, insan davranışının ve kişiliğinin birçok benzersiz özelliğini oluşturur. Çeşitli sebeplerle beynin özgül bir bölgesinin hasarı sonucu kalıcı ve karma nöropsikiyatrik klinik tablolar görülebilir. Bunlar bazen nörolojik defisitlerin, bazen de psikiyatrik bulguların hakim olduğu belirtilerle karşımıza çıkabilir. Bu tür klinik karmaşaya yol açan durumlardan biri de frontal lob sendromudur (FLS). FLS, frontal lobun prefrontal bölgesinin hasarıyla oluşur. Daha önceki davranışları normal olan bireylerde kişilik ve davranışta değişim ile karakterizedir. FLS Yüzyıl kadar önce ilk kez Harlow tarafından Phineas Gage vakası ile tanımlanmıştır. O günden bu yana frontal lob araştırmalarına her an yeni bir bilgi eklenmesine rağmen, davranışla ve kişiliğin oluşumu ile olan ilişkisi hala gizemini ve cazibesini korumaktadır. Frontal lezyonlu hastalarda gözlenen davranışsal değişikliklerin yelpazesi oldukça geniştir. Bu hastalardan bazıları çocuksu, saygısız, pasaklı, patavatsız olurken, diğerleri spontanite, merak ve insiyatif kaybına uğrarlar ve duygu, güdü, düşünme ve davranışlarda apatik bir körelme sergilerler. Yine bir kısım hasta öngörü, yargı ve içgörü kaybı gösterirken, bir kısmında da haz almayı erteleme, yaratıcılık, karmaşık davranışların düzenli olarak planlanması, çeşitli olaylara aynı anda dikkat yöneltebilme, konsantrasyon odağını, birinden diğerine esnekçe yönlendirebilme yetisinde bozulma, çok adımlı talimatları takip edebilme, anlık ama uygunsuz cevap eğilimlerinde baskılanma olmadan çıktıyı sürdürebilme yeteneklerinin her biri kayda değer biçimde bozulabilir. Ancak literatürde şizotipal kişilik bozukluğu ve FLS’nin birlikte görüldüğü bir olguya rastlanmamıştır. Biz burada; çocukluk çağında geçirilmiş bir kafa travmasının ardından gelişmiş büyüsel düşüncenin ve uyum bozukluğunun klinik tabloya hakim olduğu, FLS’li bir hastayı inceleyeceğiz
Frontal lobe syndrome with magical thinking: a case report
The human brain forms a lot of unique features of human behaviour and personality. As a result of a damage to a specific region of the human brain, with various reasons; permanent and mixed neuropsychiatric symptoms can be seen. Neurological deficits or sometimes psychiatric findings can be dominant. One of the cases which causes such a clinical complexity is the syndrome of frontal lobe (FLS). FLS is constituted by the damage of prefrontal lobe region of frontal lobe. It is characterized with the change in the behavior and the personality of the individuals whose previous behaviours were normal. FLS was first defined by Harlow with the case of Phineas Gage about one hundred [year]s ago. Since then, its relationship with the behavior and personality construct still remains its mystery. The spectrum of the behavioral changes observed in the patients with frontal lesion is quite large. While some of these patients are childish, disrespectful, shabby, tactless; the others lose their spontaneity, curiosity, and initiative and they exhibit apathic atrophy in the emotions, motive, thought, and behaviours. Again some of the patients lose their insight, foresight and judgment, some of them postpone the enjoyment, and they lose their creativity, planning the complex behaviors in regular way, and also they can’t direct their attention to various events simultaneously. The ability of manipulating the focus of concentration from one to the other in a sexible way is deteriorated. They can’t follow the instructions with multisteps. In addition to these, the ability of spontaneous but inappropriate responses while sustaining the output without pressure are deteriorated in a remarkable way. However, in the literature such a phenomenon in which the deterioration of schizotypal personality and FLS were observed together hasn’t been encountered. Here, we present a case in a patient with an earlier childhood head trauma manifesting enigmatic thought and deterioration of adaption developed later in adulthood.

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