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Yıl:2017; Cilt: 7; Sayı: 2>> Özet
Psikiyatride Güncel; 2017;7(2):95-105
Psikiyatride bilișsel ișlevlerin değerlendirilmesi
E Bora
Dokuz Eylül Üniversitesi, İzmir
Modern nöropsikolojinin doğuşuna giden tarihsel süreçte bütüncül ve lokalizasyoncu/bağlantıcı görüşler arasındaki tartışma önemli bir rol oynamıştır. Psikometrideki ve bilişsel sinirbilimdeki gelişmeler sonrası gelişen klinik nöropsikoloji, insandaki bilişsel yetileri yürütücü işlevler, bellek, dikkat, işlem hızı, sosyal bilişi içeren görece bağımsız alanlar olarak ele alır. Bu bilişsel alanlardan sorumlu görece farklılaşmış nöral ağlar olduğu genel kabul görmektedir. Ancak bu farklılaşmanın doğuştan mı geldiği yoksa gelişim sürecinde mi oluştuğu tartışmalıdır. Diğer yandan, çeşitli bilişsel alanlar arasında oldukça güçlü ilişkiler olduğu ve bilişsel işlevlerde kişiler arası görülen değişkenliğin önemli ölçüde genel bir bilişsel faktörle açıklanabileceği bilinmektedir. Ayrıca, psikiyatride görülen bilişsel bozukluklarda alana-özgüden çok genel bilişsel bozukluğun önemli olabileceğine ilişkin kanıtlar da vardır. Bu genel bilişsel faktörün (“g” faktörü) kökeninin nöropsikolojik testlerin mükemmel olmayan psikometrik özelliklerinin bir yansıması mı olduğu yoksa bilişsel işlevlerin bütüncül yapısına mı kanıt olduğu tartışma konusudur. Psikiyatrik hastalıklarda bilişsel işlev bozukluklarının eşlik etmesinin çeşitli nedenleri vardır. Bilişsel işlev bozukluğu psikiyatrik hastalıkların ortaya çıkması için bir risk faktörüdür. Bilişsel işlevlerde düşük performansa neden olan erken ve geç nörogelişimsel anormallikler aynı zamanda bazı psikiyatrik hastalıkların gelişiminde de rol oynamaktadır. Hastalık öncüsü dönemdeki madde kullanımı ve travma gibi nedenler de bilişsel işlevleri etkileyebilir. Psikiyatrik bulgularla ilişkili durumsal bilişsel bozukluklar da görülmektedir. Ayrıca psikiyatrik hastalıklara eşlik eden tıbbi durumlar, madde kullanımı ve tedavide kullanılan ilaçlar bilişsel işlev bozukluklarıyla ilişkilidir.
Cognitive assessment in psychiatry
The debate between localizationist-connectionist and holistic views of brain function had played a significant historical role in the foundation of modern neuropsychology. Clinical neuropsychology, which developed following progress in psychometrics and cognitive neuroscience, categorizes human cognition into relatively independent cognitive domains such as executive functions, memory, attention, processing speed and social cognition. It is also widely accepted that relatively differentiated neural activity is associated with each of these cognitive domains. However, it is not known whether specialization of domain-specific neural networks are innate or product of neurodevelopment during childhood and adolescence. Evidence also suggests that cognitive domains are strongly correlated with each other and a single cognitive factor can explain a large part of the variance across cognitive tests. In fact, most of the cognitive impairment in psychiatric disorders might be related to domain-general rather than domain-specific differences between patients and controls. The general cognition (“g”factor) can be considered as a support to holistic views of brain function but might be also a reflection of psychometric features of available cognitive tests. Cognitive impairment in psychiatric disorders is multi-factorial. Cognitive deficits can be risk factors for developing psychiatric disorders. Early and late neurodevelopmental abnormalities, which are associated with cognitive deficits, also play a significant role in emergence of psychiatric disorders in adolescence and adulthood. Trauma and substance abuse in premorbid years of mental disorders can also have a negative impact on cognitive development. Some cognitive deficits are state-related features secondary to symptoms of mental disorders. Co-morbid medical conditions, substance abuse and iatrogenic factors such as antipsychotic use are also associated with cognitive deficits in mental disorders.

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