Yeme Bozukluklarının Nörobiyolojisi ve Temel Psikofarmakolojik Yaklaşımlar
Özet
Yeme bozuklukları, fiziksel sağlığı ve psikososyal işleyişi ciddi derecede bozan, ölümcül sonuçları olabilen psikiyatrik rahatsızlıklardır. Tanı sistemlerinde anoreksiya nervoza, bulimia nervoza, tıkınırcasına yeme bozukluğu, kaçıngan-kısıtlayıcı gıda alımı bozukluğu, pika ve ruminasyon bozukluğu olmak üzere altı ana başlıkta ele alınmaktadır. Bu bozuklukların etiyolojisinde genetik, epigenetik, nörokimyasal faktörler, hormonal düzensizlikler ve beyin yapısındaki işlevsel değişiklikler (homeostatik, öz düzenleyici ve hedonik sistemler) karmaşık bir şekilde rol oynamaktadır. Tedavide psikofarmakolojik yaklaşımlar araştırılmakta olup, anoreksiya nervozada kilo alımı için olanzapin en umut verici ajan olarak öne çıkmaktadır. Bulimia nervoza tedavisinde etkinliği kanıtlanmış fluoksetin ve topiramat kullanımı yaygınken, tıkınırcasına yeme bozukluğunda hedonik sistemi etkileyen lisdeksamfetamin FDA onayı almış tek ilaçtır. Son yıllarda bağırsak-beyin aksının bir parçası olarak mikrobiyota çalışmalarının da bu bozuklukların anlaşılmasında önem kazandığı görülmektedir.
Eating disorders are psychiatric conditions that severely impair physical health and psychosocial functioning, potentially leading to fatal outcomes. In diagnostic systems, they are classified under six main categories: anorexia nervosa, bulimia nervosa, binge-eating disorder, avoidant/restrictive food intake disorder, pica, and rumination disorder. Genetic, epigenetic, neurochemical factors, hormonal dysregulations, and functional changes in brain structures (homeostatic, self-regulatory, and hedonic systems) play complex roles in their etiology. Psychopharmacological approaches are being investigated for treatment; olanzapine emerges as the most promising agent for weight gain in anorexia nervosa. While the use of fluoxetine and topiramate, which have proven efficacy, is common in the treatment of bulimia nervosa, lisdexamfetamine, which affects the hedonic system, is the only FDA-approved medication for binge-eating disorder. In recent years, microbiota studies as part of the gut-brain axis have also gained significance in understanding these disorders.
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