Bipolar Bozukluk Manik ve Depresif Dönemi Tanımak
Özet
Bipolar bozukluk, kişinin duygudurumunda, davranışlarında ve etkinliklerinde belirgin dalgalanmalarla seyreden, DSM-5'e göre bipolar I, bipolar II ve siklotimik bozukluk gibi alt tipleri olan kronik bir psikiyatrik rahatsızlıktır. Tanı için bipolar I'de en az bir manik dönem, bipolar II'de ise en az bir hipomanik ve bir depresif dönem öyküsü gerekirken; çökkün duygudurum, anhedoni, uyku ve iştah değişiklikleri, değersizlik hissi ile intihar düşünceleri içeren depresif ataklar klinik tabloyu karmaşıklaştırabilir. Coşku, azalmış uyku ihtiyacı, basınçlı konuşma ve riskli davranışlarla karakterize mani döneminin tespiti görece kolay olsa da, hastaların ilk başvurudan ancak 6-10 yıl sonra doğru tanı alabilmesi ve genel popülasyona kıyasla 20-30 kat yüksek olan intihar riski, erken ve doğru tanının önemini artırmaktadır. Tedavide dar terapötik pencereli lityum, valproat ve karbamazepin gibi duygudurum dengeleyiciler ile antipsikotikler kullanılırken; tremor, hepatotoksisite ve metabolik sendrom gibi ciddi yan etkiler ile kardiyovasküler hastalıklar gibi tıbbi veya anksiyete gibi psikiyatrik eş tanılar düzenli takipleri zorunlu kılar. Tarama amacıyla Duygudurum Bozuklukları Ölçeği ve Beck Depresyon Envanteri gibi özbildirim araçlarından yararlanılsa da, kesin tanı için hastayı biyopsikososyal bir bütün olarak ele alan ayrıntılı klinik değerlendirmeler şarttır.
Bipolar disorder is a chronic psychiatric condition characterized by significant fluctuations in a person's mood, behavior, and activities, with subtypes according to DSM-5 including bipolar I, bipolar II, and cyclothimic disorder. While diagnosis requires at least one manic episode for bipolar I and at least one hypomanic and one depressive episode for bipolar II, depressive episodes involving depressed mood, anhedonia, sleep and appetite changes, feelings of worthlessness, and suicidal thoughts can complicate the clinical picture. Although detecting manic episodes characterized by euphoria, decreased need for sleep, pressured speech, and risky behavior is relatively easy, the fact that individuals receive an accurate diagnosis only 6-10 years after their first admission, combined with a suicide risk 20-30 times higher than the general population, increases the importance of early and accurate diagnosis. Mood stabilizers with narrow therapeutic windows such as lithium, valproate, and carbamazepine, as well as antipsychotics, are used in treatment; however, serious side effects like tremor, hepatotoxicity, and metabolic syndrome, along with medical comorbidities such as cardiovascular diseases or psychiatric ones like anxiety, necessitate regular monitoring. Although self-report screening instruments like the Mood Disorder Questionnaire and Beck Depression Inventory are utilized, detailed clinical evaluations that address the patient as a biopsychosocial whole are essential for a definitive diagnosis.
Referanslar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). (2013). doi:http://dx.doi.org/10.1176/appi.books.9780890425596
Amerikan Psikiyatri Birliği. Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı, Beşinci Baskı (DSM-5), Tanı Ölçütleri Başvuru Elkitabı. 5th ed. (Ertuğrul Köroğlu, Çev. Ed.) Ankara: Hekimler Yayın Birliği (2014).
Gultekin B, Kesebir S, Tamam L. Bipolar disorder in Turkey: A review. Psikiyatr Guncel Yaklasimlar - Curr Approaches Psychiatry (2014) 6:1. doi:10.5455/cap.20130920014550
McIntyre RS, Berk M, Brietzke E, Goldstein BI, López-Jaramillo C, Kessing LV, Malhi GS, Nierenberg AA, Rosenblat JD, Majeed A, et al. Bipolar disorders. Lancet (2020) 396:1841–1856. doi:10.1016/S0140-6736(20)31544-0
Mitchell PB, Goodwin GM, Johnson GF, Hirschfeld RMA. Diagnostic guidelines for bipolar depression: A probabilistic approach. Bipolar Disord (2008) 10:144–152. doi:10.1111/j.1399-5618.2007.00559.x
Dagani J, Signorini G, Nielssen O, Bani M, Pastore A, Girolamo G De, Large M. Meta-analysis of the Interval between the Onset and Management of Bipolar Disorder. Can J Psychiatry (2017) 62:247–258. doi:10.1177/0706743716656607
Kessing LV, Willer I, Andersen PK, Bukh JD. Rate and predictors of conversion from unipolar to bipolar disorder: A systematic review and meta-analysis. Bipolar Disord (2017) 19:324–335. doi:10.1111/bdi.12513
Ratheesh A, Davey C, Hetrick S, Alvarez-Jimenez M, Voutier C, Bechdolf A, McGorry PD, Scott J, Berk M, Cotton SM. A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder. Acta Psychiatr Scand (2017) 135:273–284. doi:10.1111/acps.12686
Li CT, Bai YM, Huang YL, Chen YS, Chen TJ, Cheng JY, Su TP. Association between antidepressant resistance in unipolar depression and subsequent bipolar disorder: Cohort study. Br J Psychiatry (2012) 200:45–51. doi:10.1192/bjp.bp.110.086983
Tietbohl-Santos B, Chiamenti P, Librenza-Garcia D, Cassidy R, Zimerman A, Manfro GG, Kapczinski F, Passos IC. Risk factors for suicidality in patients with panic disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev (2019) 105:34–38. doi:10.1016/j.neubiorev.2019.07.022
Dong M, Lu L, Zhang L, Zhang Q, Ungvari GS, Ng CH, Yuan Z, Xiang Y, Wang G, Xiang YT. Prevalence of suicide attempts in bipolar disorder: A systematic review and meta-analysis of observational studies. Epidemiol Psychiatr Sci (2019) doi:10.1017/S2045796019000593
Miller JN, Black DW. Bipolar Disorder and Suicide: a Review. Curr Psychiatry Rep (2020) 22: doi:10.1007/s11920-020-1130-0
Vancampfort D, Firth J, Schuch FB, Rosenbaum S, Mugisha J, Hallgren M, Probst M, Ward PB, Gaughran F, De Hert M, et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry (2017) 16:308–315. doi:10.1002/wps.20458
Li XH, An FR, Ungvari GS, Ng CH, Chiu HFK, Wu PP, Jin X, Xiang YT. Prevalence of smoking in patients with bipolar disorder, major depressive disorder and schizophrenia and their relationships with quality of life. Sci Rep (2017) 7:1–7. doi:10.1038/s41598-017-07928-9
Subramaniapillai M, Arbour-Nicitopoulos K, Duncan M, McIntyre RS, Mansur RB, Remington G, Faulkner G. Physical activity preferences of individuals diagnosed with schizophrenia or bipolar disorder. BMC Res Notes (2016) 9:1–9. doi:10.1186/s13104-016-2151-y
Patel N, Viguera AC, Baldessarini RJ. Mood-Stabiliz. J Clin Psychopharmacol (2018) 38:7–10. doi:10.1097/JCP.0000000000000813
Yildiz A, Nikodem M, Vieta E, Correll CU, Baldessarini RJ. A network meta-Analysis on comparative efficacy and all-cause discontinuation of antimanic treatments in acute bipolar mania. Psychol Med (2015) 45:299–317. doi:10.1017/S0033291714001305
Demyttenaere K, Detraux J, Racagni G, Vansteelandt K. Medication-Induced Akathisia with Newly Approved Antipsychotics in Patients with a Severe Mental Illness: A Systematic Review and Meta-Analysis. CNS Drugs (2019) 33:549–566. doi:10.1007/s40263-019-00625-3
Carbon M, Kane JM, Leucht S, Correll CU. Tardive dyskinesia risk with first- and second-generation antipsychotics in comparative randomized controlled trials: a meta-analysis. World Psychiatry (2018) 17:330–340. doi:10.1002/wps.20579
Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM. Medication-induced tardive dyskinesia: A review and update. Ochsner J (2017) 17:162–174. doi:10.1043/TOJ-16-0108
Tse L, Barr A, Scarapicchia V, Vila-Rodriguez F. Neuroleptic Malignant Syndrome: A Review from a Clinically Oriented Perspective. Curr Neuropharmacol (2015) 13:395–406. doi:10.2174/1570159x13999150424113345
Erden Aki SO, Gurcan A, Gurel SC, Yazici MK. A Severe Neuroleptic Malignant Syndrome Treated with Daily Electroconvulsive Therapy: A Case Report. Turkish J Psychiatry (2021) doi:10.5080/u26535
Bostankolu G, Ayhan Y, Cuhadaroglu F, Yazıcı MK. Serotonin syndrome with a combination of aripiprazole and fluoxetine: A case report. Ther Adv Psychopharmacol (2015) 5:138–140. doi:10.1177/2045125314561467
Wang RZ, Vashistha V, Kaur S, Houchens NW. Serotonin syndrome: Preventing, recognizing, and treating it. Cleve Clin J Med (2016) 83:810–817. doi:10.3949/ccjm.83a.15129
Taylor DM, Barnes TRE, Young AH. The Maudsley® Prescribing Guidelines in Psychiatry. 14th ed. Wiley Blackwell (2021).
Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RMA, Petukhova M, Kessler RC. Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. Arch Gen Psychiatry (2007) 64:543–552. doi:10.1001/archpsyc.64.5.543
Sylvia LG, Shelton RC, Kemp DE, Bernstein EE, Friedman ES, Brody BD, Mcelroy SL, Singh V, Tohen M, Bowden CL, et al. Medical burden in bipolar disorder: Findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE). Bipolar Disord (2015) 17:212–223. doi:10.1111/bdi.12243
McIntyre RS, Konarski JZ, Yatham LN. Comorbidity in bipolar disorder: A framework for rational treatment selection. Hum Psychopharmacol (2004) 19:369–386. doi:10.1002/hup.612
Yapici Eser H, Kacar AS, Kilciksiz CM, Yalçinay-Inan M, Ongur D. Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: A Meta-Analysis and Meta-Regression Study. Front Psychiatry (2018) 9:1–15. doi:10.3389/fpsyt.2018.00229
Messer T, Lammers G, Müller-Siecheneder F, Schmidt RF, Latifi S. Substance abuse in patients with bipolar disorder: A systematic review and meta-analysis. Psychiatry Res (2017) 253:338–350. doi:10.1016/j.psychres.2017.02.067
Onyeka IN, Collier Høegh M, Nåheim Eien EM, Nwaru BI, Melle I. Comorbidity of Physical Disorders Among Patients With Severe Mental Illness With and Without Substance Use Disorders: A Systematic Review and Meta-Analysis. J Dual Diagn (2019) 15:192–206. doi:10.1080/15504263.2019.1619007
McElroy SL, Winham SJ, Cuellar-Barboza AB, Colby CL, Ho AMC, Sicotte H, Larrabee BR, Crow S, Frye MA, Biernacka JM. Bipolar disorder with binge eating behavior: A genome-wide association study implicates PRR5-ARHGAP8. Transl Psychiatry (2018) 8: doi:10.1038/s41398-017-0085-3
Hirschfeld RMA, Williams JBW, Spitzer RL, Calabrese JR, Flynn L, Keck J, Lewis L, McElroy SL, Post RM, Rapport DJ, et al. Development and validation of a screening instrument for bipolar spectrum disorder: The mood disorder questionnaire. Am J Psychiatry (2000) 157:1873–1875. doi:10.1176/appi.ajp.157.11.1873
Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD, Skeppar P, Vieta E, Scott J. The HCL-32: Towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord (2005) 88:217–233. doi:10.1016/j.jad.2005.05.011
Konuk N, Kıran S, Tamam L, Karaahmet E, Aydın H, Atık L. Duygudurum bozuklukları ölçeği’nin Türkçe uyarlamasının bipolar bozukluk taramasında geçerliği. Türk Psikiyatr Derg (2007) 18:147–154.
Vahip S, Aydemir Ö, Akkaya C, Altinbaş K, Kora K, Sücüllüoğlu Dikici D, Akdeniz F, Kalayci F, Oral ET, Vahip I, et al. Reliability and validity study of the Turkish version of Hypomania Checklist-32-Revised. Turk Psikiyatr Derg (2017) 28: doi:10.5080/u13738
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An Inventory for Measuring Depression. Arch Gen Psychiatry (1961) 4:561–571. doi:10.1001/archpsyc.1961.01710120031004
Hisli Sahin N. Beck Depresyon Envanteri’nin Geçerliği Üzerine bir Çalışma. Psikol Derg (1988) 6:118–126. Available at: https://www.academia.edu/1472683/Beck_Depresyon_Envanterinin_Geçerliği_Üzerine_bir_Çalışma [Accessed December 4, 2017]
Hisli N. Beck Depresyon Envanterinin üniversite öğrencileri için geçerlilik ve güvenilirliği. Türk Psikol Derg (1989) 7:3–13.
Öztürk MO, Uluşahin NA eds. Ruh Sağlığı ve Bozuklukları. 13th ed. Ankara: Nobel Tıp Kitabevleri (2015).
Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 10th ed. Wolters Kluwer (2017).
