Dergi Ara >>
Yıl:2011; Cilt: 1; Sayı: 2>> Özet
Psikiyatride Güncel; 2011;1(2):109-121
Obsesif-Kompulsif Bozuklukta Ektanı ve Tedavi için Öneriler
R Tükel
İstanbul Üniversitesi İstanbul Tıp Fakültesi Psikiyatri AD, İstanbul
Klinik gözlemler ve araştırmaların sonuçları, obsesif-kompulsif bozukluğa (OKB) sıklıkla başka psikiyatrik bozuklukların eşlik ettiğini göstermektedir.
OKB'de ektanıların araştırıldığı epidemiyolojik ve klinik birçok çalışmanın ortak bulgusu, OKB hastalarında en yüksek oranda
görülen I. Eksen bozukluğunun major depresif bozukluk olduğu yönündedir. OKB'ye majör depresyonun eklenmesi, obsesif-kompulsif
belirtilerin süreğenliği, hastalığın şiddeti ve işlevsellikte bozulma ile ilişkili bulunurken, bu durumun serotonin gerialım inhibitörlerine
(SGİ'ler) yanıtı olumsuz etkilemediği bildirilmiştir. Çeşitli çalışmalar, OKB'ye panik bozukluğu, özgül fobi, sosyal fobi ve yaygın anksiyete
bozukluğunun sık olarak eşlik ettiğini göstermektedir. OKB ile diğer anksiyete bozuklukları birlikte görüldüğünde, öncelikli tedavi seçeneği
SGİ'ler ve bilişsel-davranışçı tedaviler (BDT) olmalıdır. OKB ile iki uçlu bozukluk ilişkisini araştıran çalışmalarda, özellikle de OKB'nin
epizodik formu ile iki uçlu bozukluk ilişkisine vurgu yapılmaktadır. OKB ve iki uçlu bozukluk birlikte bulunduğunda, iki uçlu bozukluk, hastaların
tedavilerinin planlanmasında önceliğe sahip olmalı; hipomaniyi ya da maniyi tetikleyebilen ya da şiddetlendiren SGİ'lerle tedaviden
önce, duygudurumun dengelenmesi sağlanmalıdır. OKB ve şizofreni birlikte bulunduğunda, OKB'nin varlığının, şizofreni belirtilerini ve işlevselliği
olumsuz etkilediği gösterilmiştir. Şizofreniye OKB eşlik ettiğinde, antipsikotik tedaviye SGİ'lerin eklenmesi iyi bir tedavi seçeneği
oluşturur. Çocukluk çağı OKB'si olgularında Tourette bozukluğu yüksek oranda görülmektedir. OKB ile birlikte Tourette bozukluğunun,
tek başına görülen Tourette bozukluğu ve OKB'de n daha ciddi bir hastalık durumu oluşturduğu ve etiyolojik olarak Tourette bozukluğuna
OKB'de n daha yakın olduğu ileri sürülmüştür. Tourette bozukluğunun eşlik ettiği OKB'de , SGİ'lerle yapılan tedavilere yanıt alınmadığında,
tipik ya da atipik antipsikotik ilaçların düşük dozlardan başlayarak tedaviye eklenmesi, her iki bozukluk üzerinde iyileştirici bir etki gösterebilir.
OKB ile obsesif-kompulsif kişilik bozukluğunun birlikte olduğu hastalarda, psikodinamik psikoterapi, ekspresif yönü ön planda olan
bireysel psikoterapiler, BDT ve SSGİ'lerin etkili olduğuna ilişkin kanıtlar vardır.
Comorbidity in obsessive-compulsive disorder and treatment options

Results of clinical studies show that Axis I disorders often accompany obsessive-compulsive disorder (OCD). A common finding of many
clinical and epidemiological studies is that the most frequent Axis I disorder in OCD patients is major depressive disorder. Whereas coexistence
of major depression with OCD was found to be related to the chronicity and severity of obsessive-compulsive symptoms and
disability, response to selective serotonin reuptake inhibitor (SSRI) treatment has not been negatively affected by the presence of comorbid
major depression. Many studies show that panic disorder, specific phobia, social phobia and generalised anxiety disorder are the most common
comorbid disorders to OCD. When OCD coexists with other anxiety disorders, preferred treatment options are SSRIs and cognitivebehavioral
therapy (CBT). Results of the studies on the relationship between OCD and bipolar disorder have suggested that there might
have been a relation between bipolar disorder and episodic OCD. Bipolarity should take precedence in treatment planning when bipolar
disorder and OCD coexist. Before the treatment with SSRI which may trigger or aggravate hypomania or mania, mood has been stabilized
in bipolar OCD patients. The existence of OCD in schizophrenia patients was found to have a negative effect on symptoms, the course
of schizophrenia and functionality. When schizophrenia coexists with OCD, the use of serotonin reuptake inhibitors (SRIs), as an add-on
treatment with antipsychotic, is a good teatment option. In childhood OCD patients, Tourette disorder is seen in relatively high frequency.
It has been suggested that Tourette disorder plus OCD is more severe phenotype than OCD or Tourette disorder and etiologically may be
more closely linked to Tourette disorder than to OCD. In OCD patients with comorbid Tourette disorder, the use of combined therapy of
a SRI with typical or atypical antipsychotics, starting at a low dose and then titrating to the effective range, may be useful for both disorders,
especially when OCD patients are resistant to SRIs. There is evidence that effective psychotherapeutic approaches to the treatment of OCD
comorbid with obsessive-compulsive personality disorder are psychodynamic psychotherapy, individual psychotherapies, CBT, and SSRIs.

http://www.simplehandbaga.com/hermes-constance-bag-23cm-togo-leather-black-gold.html http://www.simplehandbaga.com/hermes-garden-party-handbag-small-31cm-red.html http://www.simplehandbaga.com/hermes-birkin-35cm-cattle-skin-vein-handbags-orange-golden.html http://www.simplehandbaga.com/hermes-jige-clutch-29cm-croco-white-grey.html http://www.simplehandbaga.com/hermes-kelly-32cm-ostrich-vein-6108-black-golden.html http://www.simplehandbaga.com/hermes-jige-clutch-29cm-croco-dark-red.html http://www.simplehandbaga.com/hermes-herbag-31cm-green-canvas-bag.html http://www.simplehandbaga.com/hermes-epsom-leather-wallet-camel-silver.html http://www.simplehandbaga.com/hermes-calf-leather-men-h-belt-138-silver-blue.html http://www.simplehandbaga.com/hermes-so-kelly-28cm-togo-leather-shoulder-bag-green-silver.html http://www.simplehandbaga.com/hermes-kelly-32cm-togo-leather-6108-electric-blue-silver.html http://www.simplehandbaga.com/hermes-epsom-leather-jige-clutch-29cm-orange.html http://www.simplehandbaga.com/hermes-birkin-30cm-togo-leather-handbag-blue-gold.html http://www.simplehandbaga.com/hermes-medor-clutch-29cm-croco-burgundy.html http://www.simplehandbaga.com/hermes-bolide-31cm-togo-leather-pink-bag.html http://www.simplehandbaga.com/hermes-birkin-35cm-handbag-crocodile-leather-green-gold.html http://www.simplehandbaga.com/hermes-constance-23cm-croco-leather-black.html http://www.simplehandbaga.com/hermes-lindy-30cm-handbag-pink-silver.html http://www.simplehandbaga.com/hermes-garden-party-handbag-small-31cm-elephant-grey.html http://www.simplehandbaga.com/hermes-birkin-35cm-togo-leather-handbags-dark-blue-golden.html http://www.simplehandbaga.com/hermes-jige-wallet-togo-leather-black.html http://www.simplehandbaga.com/hermes-dogon-wallet-togo-leather-h001-brown.html http://www.simplehandbaga.com/hermes-kelly-cut-31cm-epsom-leather-clutch-orange.html http://www.simplehandbaga.com/hermes-jige-wallet-togo-leather-electric-blue.html http://www.simplehandbaga.com/hermes-jige-wallet-togo-leather-pink.html http://www.simplehandbaga.com/hermes-h-wallet-royal-blue-silver.html http://www.simplehandbaga.com/hermes-birkin-30cm-togo-leather-handbags-black-gold.html http://www.simplehandbaga.com/hermes-kelly-cut-31cm-epsom-leather-clutch-electric-blue.html http://www.simplehandbaga.com/hermes-lindy-30cm-handbag-blue-silver.html http://www.simplehandbaga.com/hermes-dogon-wallet-togo-leather-h001-burgundy.html http://www.simplehandbaga.com/hermes-medor-clutch-29cm-croco-grey.html http://www.simplehandbaga.com/hermes-constance-bag-23cm-epsom-leather-grey-gold.html http://www.simplehandbaga.com/hermes-kelly-cut-31cm-epsom-leather-clutch-elephant-grey.html http://www.simplehandbaga.com/hermes-calf-leather-wallet-h005-red.html http://www.simplehandbaga.com/hermes-lindy-30cm-handbag-camel-gold.html http://www.simplehandbaga.com/hermes-kelly-wallet-togo-leather-black.html http://www.simplehandbaga.com/hermes-epsom-leather-jige-clutch-29cm-orange.html http://www.simplehandbaga.com/hermes-mini-evelyne-tpm-bag-pink.html http://www.simplehandbaga.com/hermes-herbag-31cm-burgundy-canvas-bag.html http://www.simplehandbaga.com/hermes-mini-kelly-22cm-epsom-leather-yellow-silver-with-chain-strap.html http://www.simplehandbaga.com/hermes-constance-bag-23cm-togo-leather-blue-silver.html http://www.simplehandbaga.com/hermes-30cm-birkin-bag-togo-leather-with-strap-light-pink-gold.html http://www.simplehandbaga.com/hermes-jige-wallet-togo-leather-blue.html http://www.simplehandbaga.com/hermes-birkin-35cm-togo-leather-handbags-rose-silver.html http://www.simplehandbaga.com/hermes-garden-party-handbag-small-31cm-brown.html http://www.simplehandbaga.com/hermes-jige-clutch-29cm-croco-green.html http://www.simplehandbaga.com/hermes-epsom-leather-jige-clutch-29cm-brown.html http://www.simplehandbaga.com/hermes-garden-party-handbag-small-31cm-blue.html http://www.simplehandbaga.com/hermes-birkin-35cm-cattle-skin-vein-handbags-blue-gold.html http://www.simplehandbaga.com/hermes-birkin-25cm-handbag-6068-orange-silver.html http://www.simplehandbaga.com/hermes-garden-party-handbag-large-36cm-black.html http://www.simplehandbaga.com/hermes-birkin-35cm-togo-leather-handbags-red-silver.html http://www.simplehandbaga.com/hermes-constance-bag-23cm-epsom-leather-pink-silver.html http://www.simplehandbaga.com/hermes-kelly-cut-31cm-epsom-leather-clutch-pink.html http://www.simplehandbaga.com/hermes-calf-leather-wallet-h005-in-orange.html http://www.simplehandbaga.com/hermes-picotin-lock-togo-leather-red.html http://www.simplehandbaga.com/hermes-mini-kelly-22cm-epsom-leather-green-silver-with-chain-strap.html http://www.simplehandbaga.com/hermes-birkin-25cm-handbag-6068-orange-silver.html http://www.simplehandbaga.com/hermes-birkin-35cm-togo-leather-handbag-yellow-gold.html http://www.simplehandbaga.com/hermes-birkin-35cm-cattle-skin-vein-handbags-orange-golden.html http://www.simplehandbaga.com/hermes-constance-bag-23cm-togo-leather-camel-gold.html http://www.simplehandbaga.com/hermes-calf-leather-men-h-belt-138-gold-light-coffee.html http://www.simplehandbaga.com/hermes-kelly-28cm-bag-togo-leather-blue-gold.html http://www.simplehandbaga.com/hermes-garden-party-handbag-small-31cm-pink.html http://www.simplehandbaga.com/hermes-garden-party-handbag-large-36cm-red.html http://www.simplehandbaga.com/hermes-birkin-30cm-togo-leather-handbag-burgundy-gold.html http://www.simplehandbaga.com/hermes-mini-evelyne-tpm-bag-dark-blue.html http://www.simplehandbaga.com/hermes-birkin-35cm-cattle-skin-vein-handbags-light-coffee-silver.html http://www.simplehandbaga.com/hermes-so-kelly-28cm-togo-leather-shoulder-bag-hot-pink-silver.html http://www.simplehandbaga.com/hermes-birkin-30cm-togo-leather-handbags-black-gold.html http://www.simplehandbaga.com/hermes-medor-clutch-29cm-croco-white.html http://www.simplehandbaga.com/hermes-garden-party-36cm-leather-handbag-black-hot-pink.html http://www.simplehandbaga.com/hermes-birkin-35cm-handbag-crocodile-leather-brown-gold.html http://www.simplehandbaga.com/hermes-constance-wallet-togo-leather-rose.html http://www.simplehandbaga.com/hermes-bi-fold-wallet-h006-black.html http://www.simplehandbaga.com/hermes-constance-bag-23cm-epsom-leather-red-gold.html http://www.simplehandbaga.com/hermes-birkin-35cm-togo-leather-handbags-black-silver.html http://www.simplehandbaga.com/hermes-mini-evelyne-tpm-bag-blue.html http://www.simplehandbaga.com/hermes-calf-leather-men-h-belt-138-silver-blue.html http://www.simplehandbaga.com/hermes-epsom-leather-jige-clutch-29cm-black.html http://www.simplehandbaga.com/hermes-epsom-leather-jige-clutch-29cm-brown.html http://www.simplehandbaga.com/hermes-bolide-31cm-togo-leather-orange-bag.html http://www.simplehandbaga.com/hermes-calf-leather-wallet-h005-h-red.html http://www.simplehandbaga.com/hermes-medor-clutch-29cm-croco-burgundy.html http://www.simplehandbaga.com/hermes-birkin-35cm-crocodile-leather-handbag-grey-white-gold.html http://www.simplehandbaga.com/hermes-lindy-30cm-handbag-red-gold.html http://www.simplehandbaga.com/hermes-birkin-35cm-cattle-skin-vein-handbags-dark-khaki-silver.html http://www.simplehandbaga.com/hermes-garden-party-36cm-canvas-handbag-yellow.html http://www.simplehandbaga.com/hermes-calf-leather-8616-handbag-cherry-pink.html http://www.simplehandbaga.com/hermes-kelly-cut-31cm-epsom-leather-clutch-orange.html http://www.simplehandbaga.com/hermes-lindy-30cm-handbag-orange-silver.html http://www.simplehandbaga.com/hermes-dogon-wallet-togo-leather-h001-blue.html http://www.simplehandbaga.com/hermes-birkin-35cm-handbag-crocodile-leather-green-gold.html http://www.simplehandbaga.com/hermes-mini-kelly-22cm-epsom-leather-yellow-silver-with-chain-strap.html http://www.simplehandbaga.com/hermes-mini-evelyne-tpm-bag-camel.html http://www.simplehandbaga.com/hermes-constance-bag-23cm-togo-leather-black-gold.html http://www.simplehandbaga.com/hermes-mini-evelyne-tpm-bag-green.html http://www.simplehandbaga.com/hermes-dogon-wallet-togo-leather-h001-green.html http://www.simplehandbaga.com/hermes-birkin-35cm-cattle-skin-vein-handbags-blue-gold.html http://www.simplehandbaga.com/hermes-constance-23cm-togo-leather-orange-silver.html