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Yıl:2023; Cilt: 34; Sayı: 1>> Özet
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Türk Psikiyatri Dergisi; 2023;34(1):50-59
Beden Odaklı Tekrarlayıcı Davranış Bozuklukları: DavranışModelleri ve Nörobiyolojik Mekanizmalar
H Günal Okumuş, D Akdemir
Hacettepe Üniversitesi, Ankara.
Amaç: Beden Odaklı Tekrarlayıcı Davranışlar (BOTD); bedenin bir parçasını ortadan kaldırmak amacıyla yapılan, istenmeyen, tekrarlayıcı ve işlevsellikte bozulmayla sonuçlanabilecek, Trikotillomani (TTM), Deri Yolma Bozukluğu (DYB), tırnak ısırma, yanak çiğneme, dudak ısırma, parmak emme, parmak çıtlatma ve diş gıcırdatma gibi motor aktiviteleri içeren bir şemsiye terimidir. Yetersiz farkındalık ve “zararsız” olarak tanımlanmaları nedeniyle klinisyenlere başvuru azdır. Epidemiyolojik verilerin net bir şekilde belirlenmesi, etiyopatogenezin aydınlatılması ve tedavi kılavuzlarının oluşturulması için yapılan çalışmalar son yıllarda büyük bir ivme kazansa da halen yetersizdir. Bu çalışmada BOTD’nin etiyolojisinin araştırılmasına yönelik çalışmaların gözden geçirilmesi amaçlanmıştır. Yöntem: Pubmed, Medline, Scopus ve Web of Science veri tabanlarında 1992-2021 yılları arasında yayınlanan makaleler gözden geçirilmiş, konuyla ilgili alan yazınında öne çıkan araştırmalar değerlendirme kapsamına alınmıştır. Bulgular: BOTD’nin etiyopatogenezine yönelik çalışmaların çoğunlukla erişkin olgularla yapıldığı ve klinik heterojenite, komorbid psikiyatrik hastalık oranlarının yüksek olması, küçük örneklem gibi birçok karıştırıcı faktör barındırdığı dikkat çekmektedir. Çalışmalar BOTD’nin davranışsal modellerle açıklanmaya çalışıldığını, yüksek oranda kalıtılabilir olduğunu ve tedavisinin planlanmasında monoamin sistemleri (özellikle glutamat ve dopamin) ile bağımlılık ögelerine yönelik girişimlerin öne çıktığını göstermektedir. Aynı zamanda nörobilişsel alanda bilişsel esneklik ve motor inhibisyon kusurları, nörogörüntüleme çalışmalarında kortiko-striato-talamo-kortikal devre anormallikleri bildirilmektedir. Sonuç: Psikiyatrik sınıflandırma sistemlerindeki yeri tartışmalı olan BOTD’nin klinik özelliklerine, yaygınlığına, etiyopatogenezine ve tedavisine yönelik çalışmalar hastalığın daha iyi anlaşılmasına ve aynı zamanda uygun şekilde tanımlanmasına katkı sağlayacaktır.
Body Focused Repetitive Behavior Disorders: Behavioral Modelsand Neurobiological Mechanisms
Objective: Body Focused Repetitive Behaviors (BFRB) is an umbrella term for undesirable, repetitive motor activities such as Trichotillomania (TTM), Skin Picking Disorder (SPD), nail biting, cheek chewing, lip biting, finger sucking, finger cracking and teeth grinding. Such behaviors are engaged in to eliminate a part of the body and may result in impaired functionality. The frequency of presentation to clinicians is low since BFRB are defined as harmless, although the number of studies on this condition has increased rapidly recently, including those making a clear determination of epidemiological data, those investigating the etiopathogenesis and those providing treatment guidelines, although they remain inadequate. The present study provides a review of studies investigating the etiology of BFRB to date. Method: Articles published between 1992 and 2021 stored in the Pubmed, Medline, Scopus and Web of Science databases were reviewed, and the prominent research studies of the condition identified were included in the evaluation. Results: Studies investigating the etiopathogenesis of BFRB were found in most cases to investigate adult populations, and were hampered by such confounding factors as clinical heterogeneity, high rates of comorbid psychiatric diseases and small sample sizes. The identified studies reveal that attempts have been made to explain BFRB based on behavioral models, and that the condition is inherited at a high rate. Treatment planning is mostly associated with monoamine systems (especially glutamate and dopamine) and interventions were directed to addiction elements. Furthermore, cognitive flexibility and motor inhibition defects in neurocognitive area and cortico-striato-thalamocortical cycle abnormalities in neuroimaging studies have been reported. Conclusion: Studies investigating the clinical features, incidence, etiopathogenesis and treatment of BFRB, which holds a controversial place in psychiatric classification systems, would contribute to a better understanding of the disease and a more appropriate definition of the condition.

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