Çocuk ve Ergenlerde Kâbus Bozukluğu
Özet
Kâbus bozukluğu, REM uykusu sırasında ortaya çıkan, yaşamı veya güvenliği tehdit eden şiddetli disforik rüyalarla karakterize bir parasomni türüdür ve çocuklarda yetişkinlere oranla daha yaygın görülmektedir. Genellikle 3-6 yaşlarında başlayan bu durum, haftalık görülme sıklığına göre hafiften ağıra doğru derecelendirilir ve altı aydan uzun sürmesi durumunda kronik olarak kabul edilir. Etiyolojisinde genetik yatkınlığın yanı sıra, travma sonrası stres bozukluğu (TSSB), anksiyete ve nörokognitif modeldeki emosyon regülasyon bozuklukları gibi faktörler rol oynamaktadır. Klinik olarak, çocukların uyandığında hızla oryante olabilmesi ve rüyayı net hatırlamasıyla uyku teröründen ayrılan kâbus bozukluğu; akademik başarıda düşüş, davranışsal problemler ve sosyal işlevsellikte bozulma ile ilişkilidir. Tanı için genellikle detaylı bir anamnez yeterli görülürken, tedavide uyku hijyeninin düzenlenmesi önceliklidir. Daha dirençli olgularda, rüya içeriğini değiştirmeye dayalı imgeleme prova terapisi (IRT) gibi psikoterapötik yaklaşımlar veya TSSB ile ilişkili durumlarda prazosin gibi farmakolojik seçenekler tercih edilmektedir. Sonuç olarak, kâbus bozukluğunun erken dönemde tanınması ve müdahale edilmesi, çocukların fiziksel ve ruhsal gelişimi ile yaşam kalitesinin korunması açısından kritik önem taşımaktadır.
Nightmare disorder is a type of parasomnia characterized by severe dysphoric dreams that threaten life or safety, occurring during REM sleep, and it is more common in children than in adults. Usually beginning between the ages of 3-6, this condition is graded from mild to severe based on weekly frequency and is considered chronic if it lasts longer than six months. In its etiology, genetic predisposition as well as factors such as post-traumatic stress disorder (PTSD), anxiety, and emotion regulation disorders in the neurocognitive model play a role. Clinically distinguished from sleep terrors by the child's ability to become quickly oriented upon waking and clearly remember the dream, nightmare disorder is associated with decreased academic success, behavioral problems, and impaired social functioning. While a detailed anamnesis is generally sufficient for diagnosis, organizing sleep hygiene is the priority in treatment. In more resistant cases, psychotherapeutic approaches such as imagery rehearsal therapy (IRT), based on changing dream content, or pharmacological options like prazosin in cases associated with PTSD are preferred. Consequently, early recognition and intervention of nightmare disorder are of critical importance for protecting the physical and mental development and quality of life of children.
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