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Yıl:2012; Cilt: 5; Sayı: 1>> Özet
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2012;5(1):67-75
Erişkin Dikkat Eksikliği/Hiperaktivite Bozukluğunda Farmakolojik Tedavi
H Baykan, Lİ Yargıç
Ümraniye Eğitim ve Araştırma Hastanesi, İstanbul
Erişkinlikte Dikkat Eksikliği/Hiperaktivite Bozukluğu (DEHB)'na tanı konulması ve tedavi edilmesi son yıllarda psikiyatride üzerinde çok durulan konulardan biri olmuştur. Çünkü DEHB genel toplumdaki erişkinlerin %4'ü nden fazlasını etkilemesine karşın, yeterince fark edilemediğinden doğru tedavi edilememektedir. DEHB birçok psikiyatrik hastalıkla bir arada olabilmekte ve tedavi edilmediğinde hastanın sosyal hayatı ve evlilik ilişkilerinde çatışmalara; yeterli zihinsel kapasitesi olmasına rağmen okul hayatı, iş hayatı ve ekonomik durumunda kendisinden beklenen yerlere gelememeye neden olmaktadır. Bu nedenle DEHB'nin erişkin psikiyatristleri tarafından bilinmesi, tanınması ve tedavi edilmesi oldukça önem taşımaktadır. Çocukluk çağındaki DEHB'nin farmakolojik tedavisi daha iyi bilinmekle birlikte aynı ilaçların erişkinde kullanılmasına yönelik çalışmalar hala sürmektedir. Erişkinlerde DEHB tedavisinin belirtilerde belirgin bir düzelme sağladığı gösterilmiştir. Ayrıca eşlik eden depresyon, anksiyete bozuklukları, madde kötüye kullanımı gibi komorbid durumlar sıklıkla tabloya hakim olabildiğinden, eşlik eden psikiyatrik bozukluk ve belirtilerin tedavi edilmesi önem taşımaktadır. Tedavide ilk seçenek farmakoterapi olup günümüzde özellikle üç ilaç; amfetamin, metilfenidat ve atomoksetin FDA tarafından erişkinlerde kullanımı onaylanmış ve yaygın olarak kullanılmaktadır. Bunlardan metilfenidat ve atomoksetin ülkemizde de 25 yaşına kadar olan erişkinlerde DEHB tedavisi için T.C. Sağlık Bakanlığı tarafından onaylanmıştır. Bunların dışındaki bazı ilaçlar da tedavide denenmekteyse de hiçbiri bu üç seçenek kadar etkili olmayıp tedavide birinci tercih olarak düşünülmemelidir.
Pharmacotherapy of Attention Deficit/Hyperactivity Disorder in Adults
Diagnosis and treatment of Attention Deficit/Hyperactivity Disorder (ADHD) in adults has been one of the most popular topics of psychiatry in recent [year]s. Although ADHD is a prevalent disorder estimated to affect more than 4% of adult population, it is not adequately realized and treated. ADHD may co-occur with several psychiatric disorders and if it is not treated, it may cause conflicts in social and marital relations, and underachievement in academics, career and economic status in spite of adequate intellectual abilities. Therefore it is very important for the adult psychiatry experts to recognize, understand and treat ADHD. Although the treatment of ADHD has been widely studied in children, the studies about the use of the same medications in adults are still evolving. Treatment of ADHD in adults provides a significant relief in symptoms. As comorbid depression, anxiety disorders and substance abuse may dominate the clinical picture, it is crucial to treat these psychiatric disorders and symptoms. Today, the first choice in the treatment is pharmacotherapy. Three medications; amphetamines, methylphenidate and atomoxetine have been approved by FDA for adult ADHD and are widely used. Among these, methylphenidate and atomoxetine have been approved by the Turkish Ministry of Health for the treatment of ADHD until age of 25. Some other medications are also tried in the treatment of ADHD; however, none of them are as effective as these three and they should not be considered as a first choice in treatment.

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